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Ivanova D, Newell D, Field J, Bishop FL. The development of working alliance in early stages of care from the perspective of patients attending a chiropractic teaching clinic. Chiropr Man Therap 2024; 32:10. [PMID: 38515190 PMCID: PMC10958961 DOI: 10.1186/s12998-023-00527-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 12/21/2023] [Indexed: 03/23/2024] Open
Abstract
BACKGROUND The clinician-patient relationship has consistently been found to predict treatment success in both physical and mental health settings. This relationship has been operationalised in the literature as "Working Alliance," which consists of three key components: patient-clinician agreement on the goals of care, agreement on the tasks required to achieve those goals, and the establishment of a strong bond. While research has demonstrated the impact of working alliance in physical health settings, it often measures working alliance early in patients' care journeys. However, no primary research has investigated how early working alliance develops between patients and chiropractors. Evidence suggests that musculoskeletal practitioners may require further training to feel confident in establishing working alliance. Therefore, this study aims to explore the development of working alliance in the early stages of chiropractic care from the patients' perspective to inform evidence-based practice. METHODS Participants for this qualitative study were recruited from a teaching clinic at a specialised healthcare professions training university in the United Kingdom between September 2022 and April 2023. A total of 25 adult patients completed semi-structured interviews during the early stages of their care. The interview transcripts were analysed using Reflexive Thematic Analysis, from a critical realist stance. RESULTS The findings highlight that an early working alliance entails the gradual development of patients' confidence in their decision to seek help from trainee chiropractors to alleviate their symptoms. The four themes describe the impact of the clinical context on patients' expectations, the trainee chiropractors' qualities that participants considered important for early working alliance, the role of explanations, and the interplay between pain and early working alliance. CONCLUSIONS Establishing an early trainee chiropractor-patient working alliance involves a process of building patients' confidence in the trainee chiropractors' expertise, identifying the correct goals of care, and recognising the value of the proposed treatment plan. Factors shaping this process include the context of the care journey, patients' perceptions of trainee chiropractors' qualities, their bodily sensations, their expectations, their past experiences, and their satisfaction with trainee chiropractors' explanations.
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Affiliation(s)
- Dima Ivanova
- School of Psychology, University of Southampton, University Road, Southampton, Hampshire, SO17 1BJ, UK.
| | - Dave Newell
- AECC University College, Parkwood Campus, Parkwood Road, Bournemouth, Dorset, BH5 2DF, UK
| | | | - Felicity L Bishop
- School of Psychology, University of Southampton, University Road, Southampton, Hampshire, SO17 1BJ, UK
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2
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Bishop FL, Cross N, Dewar-Haggart R, Teasdale E, Herbert A, Robinson ME, Ridd MJ, Mallen C, Clarson L, Bostock J, Becque T, Stuart B, Garfield K, Morrison L, Pollet S, Vennik J, Atherton H, Howick J, Leydon GM, Nuttall J, Islam N, Lee PH, Little P, Everitt HA. Talking in primary care (TIP): protocol for a cluster-randomised controlled trial in UK primary care to assess clinical and cost-effectiveness of communication skills e-learning for practitioners on patients' musculoskeletal pain and enablement. BMJ Open 2024; 14:e081932. [PMID: 38508652 PMCID: PMC10953007 DOI: 10.1136/bmjopen-2023-081932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 03/01/2024] [Indexed: 03/22/2024] Open
Abstract
INTRODUCTION Effective communication can help optimise healthcare interactions and patient outcomes. However, few interventions have been tested clinically, subjected to cost-effectiveness analysis or are sufficiently brief and well-described for implementation in primary care. This paper presents the protocol for determining the effectiveness and cost-effectiveness of a rigorously developed brief eLearning tool, EMPathicO, among patients with and without musculoskeletal pain. METHODS AND ANALYSIS A cluster randomised controlled trial in general practitioner (GP) surgeries in England and Wales serving patients from diverse geographic, socioeconomic and ethnic backgrounds. GP surgeries are randomised (1:1) to receive EMPathicO e-learning immediately, or at trial end. Eligible practitioners (eg, GPs, physiotherapists and nurse practitioners) are involved in managing primary care patients with musculoskeletal pain. Patient recruitment is managed by practice staff and researchers. Target recruitment is 840 adults with and 840 without musculoskeletal pain consulting face-to-face, by telephone or video. Patients complete web-based questionnaires at preconsultation baseline, 1 week and 1, 3 and 6 months later. There are two patient-reported primary outcomes: pain intensity and patient enablement. Cost-effectiveness is considered from the National Health Service and societal perspectives. Secondary and process measures include practitioner patterns of use of EMPathicO, practitioner-reported self-efficacy and intentions, patient-reported symptom severity, quality of life, satisfaction, perceptions of practitioner empathy and optimism, treatment expectancies, anxiety, depression and continuity of care. Purposive subsamples of patients, practitioners and practice staff take part in up to two qualitative, semistructured interviews. ETHICS APPROVAL AND DISSEMINATION Approved by the South Central Hampshire B Research Ethics Committee on 1 July 2022 and the Health Research Authority and Health and Care Research Wales on 6 July 2022 (REC reference 22/SC/0145; IRAS project ID 312208). Results will be disseminated via peer-reviewed academic publications, conference presentations and patient and practitioner outlets. If successful, EMPathicO could quickly be made available at a low cost to primary care practices across the country. TRIAL REGISTRATION NUMBER ISRCTN18010240.
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Affiliation(s)
| | - Nadia Cross
- Primary Care Research Centre, School of Primary Care, Population Science, and Medical Education, University of Southampton, Southampton, UK
| | - Rachel Dewar-Haggart
- School of Psychology, University of Southampton, Southampton, UK
- Primary Care Research Centre, School of Primary Care, Population Science, and Medical Education, University of Southampton, Southampton, UK
| | - Emma Teasdale
- School of Psychology, University of Southampton, Southampton, UK
- Primary Care Research Centre, School of Primary Care, Population Science, and Medical Education, University of Southampton, Southampton, UK
| | - Amy Herbert
- Centre of Academic Primary Care, Bristol Medical School, University of Bristol, Bristol, UK
| | | | - Matthew J Ridd
- Population Health Sciences, University of Bristol Faculty of Health Sciences, Bristol, UK
| | - Christian Mallen
- Keele School of Medicine, Keele University, Newcastle-under-Lyme, UK
| | - Lorna Clarson
- Keele School of Medicine, Keele University, Newcastle-under-Lyme, UK
| | - Jennifer Bostock
- Primary Care Research Centre, School of Primary Care, Population Science, and Medical Education, University of Southampton, Southampton, UK
| | - Taeko Becque
- Primary Care Research Centre, School of Primary Care, Population Science, and Medical Education, University of Southampton, Southampton, UK
| | - Beth Stuart
- Wolfson Institute of Population Health, Queen Mary University of London, London, London, UK
| | - Kirsty Garfield
- Health Economics Bristol, Population Health Sciences, University of Bristol, Bristol, Bristol, UK
| | - Leanne Morrison
- School of Psychology, University of Southampton, Southampton, UK
- Primary Care Research Centre, School of Primary Care, Population Science, and Medical Education, University of Southampton, Southampton, UK
| | - Sebastien Pollet
- School of Psychology, University of Southampton, Southampton, UK
- Primary Care Research Centre, School of Primary Care, Population Science, and Medical Education, University of Southampton, Southampton, UK
| | - Jane Vennik
- Primary Care Research Centre, School of Primary Care, Population Science, and Medical Education, University of Southampton, Southampton, UK
| | - Helen Atherton
- Primary Care Research Centre, School of Primary Care, Population Science, and Medical Education, University of Southampton, Southampton, UK
- Unit of Academic Primary Care, University of Warwick, Coventry, UK
| | - Jeremy Howick
- Leicester Medical School, University of Leicester, Leicester, UK
- Faculty of Philosophy, University of Oxford, Oxford, UK
| | - Geraldine M Leydon
- Primary Care Research Centre, School of Primary Care, Population Science, and Medical Education, University of Southampton, Southampton, UK
| | - Jacqui Nuttall
- Southampton Clinical Trials Unit, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Nazrul Islam
- Primary Care Research Centre, School of Primary Care, Population Science, and Medical Education, University of Southampton, Southampton, UK
| | - Paul H Lee
- Southampton Clinical Trials Unit, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Paul Little
- Primary Care Research Centre, School of Primary Care, Population Science, and Medical Education, University of Southampton, Southampton, UK
| | - Hazel A Everitt
- Primary Care Research Centre, School of Primary Care, Population Science, and Medical Education, University of Southampton, Southampton, UK
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3
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Ford AC, Wright-Hughes A, Alderson SL, Ow PL, Ridd MJ, Foy R, Bianco G, Bishop FL, Chaddock M, Cook H, Cooper D, Fernandez C, Guthrie EA, Hartley S, Herbert A, Howdon D, Muir DP, Nath T, Newman S, Smith T, Taylor CA, Teasdale EJ, Thornton R, Farrin AJ, Everitt HA. Amitriptyline at Low-Dose and Titrated for Irritable Bowel Syndrome as Second-Line Treatment in primary care (ATLANTIS): a randomised, double-blind, placebo-controlled, phase 3 trial. Lancet 2023; 402:1773-1785. [PMID: 37858323 DOI: 10.1016/s0140-6736(23)01523-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Revised: 06/30/2023] [Accepted: 07/20/2023] [Indexed: 10/21/2023]
Abstract
BACKGROUND Most patients with irritable bowel syndrome (IBS) are managed in primary care. When first-line therapies for IBS are ineffective, the UK National Institute for Health and Care Excellence guideline suggests considering low- dose tricyclic antidepressants as second-line treatment, but their effectiveness in primary care is unknown, and they are infrequently prescribed in this setting. METHODS This randomised, double-blind, placebo-controlled trial (Amitriptyline at Low-Dose and Titrated for Irritable Bowel Syndrome as Second-Line Treatment [ATLANTIS]) was conducted at 55 general practices in England. Eligible participants were aged 18 years or older, with Rome IV IBS of any subtype, and ongoing symptoms (IBS Severity Scoring System [IBS-SSS] score ≥75 points) despite dietary changes and first-line therapies, a normal full blood count and C-reactive protein, negative coeliac serology, and no evidence of suicidal ideation. Participants were randomly assigned (1:1) to low-dose oral amitriptyline (10 mg once daily) or placebo for 6 months, with dose titration over 3 weeks (up to 30 mg once daily), according to symptoms and tolerability. Participants, their general practitioners, investigators, and the analysis team were all masked to allocation throughout the trial. The primary outcome was the IBS-SSS score at 6 months. Effectiveness analyses were according to intention-to-treat; safety analyses were on all participants who took at least one dose of the trial medication. This trial is registered with the ISRCTN Registry (ISRCTN48075063) and is closed to new participants. FINDINGS Between Oct 18, 2019, and April 11, 2022, 463 participants (mean age 48·5 years [SD 16·1], 315 [68%] female to 148 [32%] male) were randomly allocated to receive low-dose amitriptyline (232) or placebo (231). Intention-to-treat analysis of the primary outcome showed a significant difference in favour of low-dose amitriptyline in IBS-SSS score between groups at 6 months (-27·0, 95% CI -46·9 to -7·10; p=0·0079). 46 (20%) participants discontinued low-dose amitriptyline (30 [13%] due to adverse events), and 59 (26%) discontinued placebo (20 [9%] due to adverse events) before 6 months. There were five serious adverse reactions (two in the amitriptyline group and three in the placebo group), and five serious adverse events unrelated to trial medication. INTERPRETATION To our knowledge, this is the largest trial of a tricyclic antidepressant in IBS ever conducted. Titrated low-dose amitriptyline was superior to placebo as a second-line treatment for IBS in primary care across multiple outcomes, and was safe and well tolerated. General practitioners should offer low-dose amitriptyline to patients with IBS whose symptoms do not improve with first-line therapies, with appropriate support to guide patient-led dose titration, such as the self-titration document developed for this trial. FUNDING National Institute for Health and Care Research Health Technology Assessment Programme (grant reference 16/162/01).
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Affiliation(s)
- Alexander C Ford
- Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK; Leeds Gastroenterology Institute, St James's University Hospital, Leeds, UK.
| | - Alexandra Wright-Hughes
- Clinical Trial Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Sarah L Alderson
- Clinical Trial Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Pei-Loo Ow
- Clinical Trial Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Matthew J Ridd
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Robbie Foy
- Leeds Institute of Health Sciences, School of Medicine, University of Leeds, Leeds, UK
| | - Gina Bianco
- Clinical Trial Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Felicity L Bishop
- Centre for Clinical and Community Applications of Health Psychology, School of Psychology, University of Southampton, Southampton, UK
| | | | - Heather Cook
- Clinical Trial Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Deborah Cooper
- Leeds Institute of Health Sciences, School of Medicine, University of Leeds, Leeds, UK
| | - Catherine Fernandez
- Clinical Trial Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Elspeth A Guthrie
- Leeds Institute of Health Sciences, School of Medicine, University of Leeds, Leeds, UK
| | - Suzanne Hartley
- Clinical Trial Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Amy Herbert
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Daniel Howdon
- Leeds Institute of Health Sciences, School of Medicine, University of Leeds, Leeds, UK
| | - Delia P Muir
- Clinical Trial Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Taposhi Nath
- Clinical Trial Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Sonia Newman
- Primary Care Research Centre, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Thomas Smith
- Clinical Trial Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Christopher A Taylor
- Clinical Trial Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Emma J Teasdale
- Centre for Clinical and Community Applications of Health Psychology, School of Psychology, University of Southampton, Southampton, UK
| | - Ruth Thornton
- Primary Care Research Centre, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Amanda J Farrin
- Clinical Trial Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Hazel A Everitt
- Primary Care Research Centre, Faculty of Medicine, University of Southampton, Southampton, UK
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Towler LB, Graham CA, Bishop FL, Hinchliff S. Sex and Relationships in Later Life: Older Adults' Experiences and Perceptions of Sexual Changes. J Sex Res 2023; 60:1318-1331. [PMID: 35852483 DOI: 10.1080/00224499.2022.2093322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
The aim of this study was to explore the sexual lives of older adults in the UK to elucidate their experiences of sexual changes and problems, and the role of intimacy and interpersonal support in coping with these changes. We conducted in-depth semi-structured interviews with 31 participants (aged 66-92, mean = 74, 16 women and 15 men), analyzed using reflexive thematic analysis. Our analysis generated three themes: Sexual Changes are "Natural," Sex is the Icing on the Cake, and Maintaining Sexual Connection and Relationship Satisfaction. The participants often rationalized and accepted sexual changes and problems as part of the natural aging process, or as a consequence of other age-related health issues. Sexual activity was seen by many as the "icing on the cake" of a satisfying romantic relationship, built on strong foundations of intimacy, connection, and companionship. Relationship satisfaction and sexual wellbeing can be maintained despite changes to sexual function by retaining a sexual connection through shared experiences, emotional closeness, and support. The findings have important implications for researchers and health providers, and suggest that adopting an "affirmative older age" perspective would be useful for not only future research but also when providing support for older adults with sexual difficulties.
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Affiliation(s)
| | | | | | - Sharron Hinchliff
- Division of Nursing and Midwifery, Health Sciences School, University of Sheffield
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Vennik J, Hughes S, Lyness E, McDermott C, Smith KA, Steele M, Bostock J, Howick J, Little P, Leydon G, Mallen C, Morrison L, Stuart B, Everitt H, Bishop FL. Patient perceptions of empathy in primary care telephone consultations: A mixed methods study. Patient Educ Couns 2023; 113:107748. [PMID: 37141693 DOI: 10.1016/j.pec.2023.107748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Accepted: 04/10/2023] [Indexed: 05/06/2023]
Abstract
OBJECTIVE Clinical empathy can enhance patient outcomes. This study examined patients' perceptions of empathy in primary care consultations delivered by telephone. METHODS A mixed methods study was nested in a larger feasibility study conducted May-October 2020. Adults reporting a UK primary care consultation in the previous 2 weeks completed an online survey. A sample of survey respondents participated in a semi-structured qualitative interview. Interviews were analysed thematically. RESULTS Survey respondents (n = 359) rated practitioners as between 'good' and 'very good' at established patient-reported indicators of clinical empathy. Telephone consultations were rated slightly lower than face-to-face or other consultations. 30 survey respondents were interviewed. Three qualitative themes identified how telephone consultations can shape clinical empathy: setting for an empathic encounter; feeling connected; being acknowledged. CONCLUSION Primary care patients typically perceive good levels of clinical empathy in telephone consultations; specific features of telephone consultations may facilitate and/or hinder clinical empathy. PRACTICE IMPLICATIONS To ensure patients feel listened to, acknowledged and understood, practitioners may need to increase their empathic verbalisations in telephone consultations. By using verbal responses to demonstrate active listening and by clearly describing and/or implementing next steps in management, practitioners may be able to enhance clinical empathy in telephone consultations.
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Affiliation(s)
- Jane Vennik
- Primary Care Research Centre, University of Southampton, Southampton, UK
| | - Stephanie Hughes
- Primary Care Research Centre, University of Southampton, Southampton, UK
| | - Emily Lyness
- Primary Care Research Centre, University of Southampton, Southampton, UK
| | - Clare McDermott
- Primary Care Research Centre, University of Southampton, Southampton, UK
| | - Kirsten A Smith
- Primary Care Research Centre, University of Southampton, Southampton, UK; School of Computing, University of Portsmouth, Portsmouth, UK
| | - Mary Steele
- Primary Care Research Centre, University of Southampton, Southampton, UK
| | | | - Jeremy Howick
- Faculty of Philosophy, University of Oxford, Oxford, UK
| | - Paul Little
- Primary Care Research Centre, University of Southampton, Southampton, UK
| | - Geraldine Leydon
- Primary Care Research Centre, University of Southampton, Southampton, UK
| | | | - Leanne Morrison
- Primary Care Research Centre, University of Southampton, Southampton, UK; Centre for Clinical and Community Applications of Health Psychology, University of Southampton, Southampton, UK
| | - Beth Stuart
- Primary Care Research Centre, University of Southampton, Southampton, UK; Centre for Evaluation and Methods Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | - Hazel Everitt
- Primary Care Research Centre, University of Southampton, Southampton, UK
| | - Felicity L Bishop
- Centre for Clinical and Community Applications of Health Psychology, University of Southampton, Southampton, UK.
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Budd G, Griffiths D, Howick J, Vennik J, Bishop FL, Durieux N, Everitt HA. Empathy in patient-clinician interactions when using telecommunication: A rapid review of the evidence. PEC Innovation 2022; 1:100065. [PMID: 35996734 PMCID: PMC9385203 DOI: 10.1016/j.pecinn.2022.100065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Revised: 07/04/2022] [Accepted: 07/12/2022] [Indexed: 12/01/2022]
Abstract
Objectives The COVID-19 pandemic accelerated the replacement of many face-to-face healthcare consultations with telephone consultations. Little is known about the extent to which empathy can be expressed in telephone consultations. Our objective is to review evidence related to empathy in telephone consultations including clinical outcomes, and patient/practitioner experiences. Methods Searches of Medline/Ovid and PsycINFO/Ovid were undertaken. Titles and abstract screening, data extraction, and risk of bias were undertaken by two reviewers. Discrepancies were resolved in discussion with additional reviewers. Included studies were specific to tele-communications with empirical data on empathy related to patient outcomes/views, published (in English), 2010–2021. Studies that did not mention empathy explicitly were excluded. Results Our search yielded 740 individual records and 8 studies (527 patients, 20 practitioners) met inclusion criteria: Some barriers to expression of empathy were noted, but no major obstacles were reported. However, data was sparse and most studies had a high risk of bias. Conclusion Empathy in telephone consultations is possible, (though the loss of non-verbal cues and touch can present barriers) however the research does not yet identify how. Innovation It is possible to establish and display empathy in telephone consultations, but future research needs to identify how this can be optimized. Funding This work was supported by a 10.13039/501100000272National Institute for Health Research (NIHR) 10.13039/501100013374School for Primary Care Research grant (project number 389). The 10.13039/501100000739University of Southampton's Primary Care Department is a member of the 10.13039/501100013374NIHR School for Primary Care Research and supported by NIHR Research funds. The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care. Protocol registration. PROSPERO (CRD42021238087).
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Affiliation(s)
- Georgina Budd
- College of Human and Health Sciences, Swansea University. Haldane Building, University Singleton Park Campus, Sketty, Swansea SA2 8PP, UK
- Corresponding author at: College of Human and Health Sciences, Swansea University, Haldane Building, University Singleton Park Campus, Sketty, Swansea SA2 8PP, UK.
| | - Dan Griffiths
- Centre for Clinical and Community Applications of Health Psychology, University of Southampton, School of Psychology (B44), University Rd, Highfield, Southampton SO17 1BJ, UK
| | - Jeremy Howick
- Faculty of Philosophy, University of Oxford, Radcliffe Primary Care Building, Radcliffe Observatory Quarter, Woodstock Rd, Oxford OX2 6GG, UK
| | - Jane Vennik
- Primary Care Research Center, University of Southampton. Aldermoor Health Centre, Aldermoor Close Southampton, SO16 5ST, UK
| | - Felicity L. Bishop
- Centre for Clinical and Community Applications of Health Psychology, University of Southampton, School of Psychology (B44), University Rd, Highfield, Southampton SO17 1BJ, UK
- Research Unit for a life-Course perspective on Health & Education, Faculty of Psychology, Speech and Language Therapy, and Educational Sciences, University of Liege, Place des Orateurs 2, 4000 Liège, Belgium
| | - Nancy Durieux
- Research Unit for a life-Course perspective on Health & Education, Faculty of Psychology, Speech and Language Therapy, and Educational Sciences, University of Liege, Place des Orateurs 2, 4000 Liège, Belgium
| | - Hazel A. Everitt
- Primary Care Research Center, University of Southampton. Aldermoor Health Centre, Aldermoor Close Southampton, SO16 5ST, UK
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Ivanova D, Bishop FL, Newell D, Field J, Walsh M. Mixed methods systematic review of the literature base exploring working alliance in the chiropractic profession. Chiropr Man Therap 2022; 30:35. [PMID: 36056368 PMCID: PMC9438171 DOI: 10.1186/s12998-022-00442-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 07/06/2022] [Indexed: 11/10/2022] Open
Abstract
Background The construct of working alliance has been used to operationalise the patient–clinician relationship. Research evidence from the rehabilitation literature has established an association between the construct and several patient outcomes. The aim of this systematic literature review was to study working alliance in the chiropractic discipline. Method This review followed a mixed method systematic review methodology: EBSCO (The Allied and Complementary Medicine Database), EBSCO (MEDLINE), EBSCO PsycINFO, Web of Science Core Collection, Chiro index, and grey literature were searched for quantitative, qualitative, and mixed methods studies on 17th March 2021. Qualitative appraisal was conducted using the Mixed Methods Appraisal Tool, version 2018. The qualitative component was synthesised via thematic synthesis and explored patients’ and chiropractors’ perceptions of the nature and role of working alliance. The quantitative component was synthesised via narrative synthesis to examine how the construct has been measured in research and what its effect on clinical outcomes and patient satisfaction is. The findings were integrated in the discussion section. Results Thirty studies were included. The qualitative component found that both patients and chiropractors consider working alliance as a key factor in the treatment journey. The findings illustrated that the construct includes the bond between a patient and a chiropractor which is underpinned by trust and attentiveness to patients’ needs, values and preferences. Qualitative data also suggested that strong working alliance has the potential to improve patients’ adherence to treatment and that it is characterised by ongoing negotiation of expectations about the goals of care and the tasks involved in the treatment plan. The quantitative component highlighted that even though working alliance is relevant to the chiropractic discipline, very few studies have quantitatively measured the construct and its effect. Conclusion The findings of this review emphasise the subjective importance of working alliance in the chiropractic clinical encounter. However, there were not enough homogenous studies measuring the effect of working alliance on clinical outcomes and patient satisfaction to conduct a meta-analysis. Future research should focus on evaluating potential direct and mediated effects on patient outcomes. Supplementary Information The online version contains supplementary material available at 10.1186/s12998-022-00442-4.
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Affiliation(s)
- Dima Ivanova
- University of Southampton, University Road, Southampton, SO17 1BJ, Hampshire, UK.
| | - Felicity L Bishop
- University of Southampton, University Road, Southampton, SO17 1BJ, Hampshire, UK
| | - Dave Newell
- University of Southampton, University Road, Southampton, SO17 1BJ, Hampshire, UK.,Anglo European College of Chiropractic University College, Parkwood Campus, Parkwood Road, Bournemouth, BH5 2DF, Dorset, UK
| | - Jonathan Field
- University of Southampton, University Road, Southampton, SO17 1BJ, Hampshire, UK
| | - Madeleine Walsh
- University of Southampton, University Road, Southampton, SO17 1BJ, Hampshire, UK
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Paskins Z, Farmer CE, Manning F, Andersson DA, Barlow T, Bishop FL, Brown CA, Clark A, Clark EM, Dulake D, Gulati M, Le Maitre CL, Jones RK, Loughlin J, Mason DJ, McCarron M, Millar NL, Pandit H, Peat G, Richardson SM, Salt EJ, Taylor EJ, Troeberg L, Wilcox RK, Wise E, Wilkinson C, Watt FE. Research priorities to reduce the impact of musculoskeletal disorders: a priority setting exercise with the child health and nutrition research initiative method. Lancet Rheumatol 2022; 4:e635-e645. [PMID: 36275038 PMCID: PMC9584828 DOI: 10.1016/s2665-9913(22)00136-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Involving research users in setting priorities for research is essential to ensure the outcomes are patient-centred and maximise its value and impact. The Musculoskeletal Disorders Research Advisory Group Versus Arthritis led a research priority setting exercise across musculoskeletal disorders. The Child Health and Nutrition Research Initiative (CHNRI) method of setting research priorities with a range of stakeholders was used, involving four stages and two surveys, to: (1) gather research uncertainties, (2) consolidate these, (3) score uncertainties against importance and impact, and (4) analyse scoring for prioritisation. 213 people responded to the first survey and 285 people to the second, representing clinicians, researchers, and people with musculoskeletal disorders. Key priorities included developing and testing new treatments, better treatment targeting, early diagnosis, prevention, and better understanding and management of pain, with an emphasis on understanding underpinning mechanisms. We present a call to action to researchers and funders to target these priorities.
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Affiliation(s)
- Zoe Paskins
- Primary Care Centre Versus Arthritis, Keele University, Keele, UK
| | | | - Fay Manning
- School of Medicine, Keele University, Keele, UK
- College of Medicine and Health, University of Exeter, Exeter, UK
| | - David A Andersson
- Wolfson CARD, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Tim Barlow
- Department of Orthopaedics, Wrightington Hospital, Wigan, UK
| | | | | | | | - Emma M Clark
- Bristol Medical School, University of Bristol, UK
| | | | - Malvika Gulati
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | | | - Richard K Jones
- Centre for Health Sciences Research, University of Salford, Manchester, UK
| | - John Loughlin
- Biosciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | | | - Maura McCarron
- Department of Rheumatology, Belfast Health and Social Care Trust, Belfast, UK
| | - Neil L Millar
- Institute of Infection, Immunity and Inflammation, College of Medicine, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Hemant Pandit
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | - George Peat
- Primary Care Centre Versus Arthritis, Keele University, Keele, UK
| | - Stephen M Richardson
- Division of Cell Matrix Biology and Regenerative Medicine, School of Biological Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK
| | - Emma J Salt
- Primary Care Centre Versus Arthritis, Keele University, Keele, UK
- University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK
| | | | - Linda Troeberg
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Ruth K Wilcox
- Institute of Medical and Biological Engineering, University of Leeds, Leeds, UK
| | - Elspeth Wise
- Talbot Medical Centre, South Shields & Primary Care Rheumatology and Musculoskeletal Medicine Society, South Shields, UK
| | | | - Fiona E Watt
- Department of Immunology and Inflammation, Imperial College London, London, UK
- Correspondence to: Dr Fiona E Watt, Department of Immunology and Inflammation, Hammersmith Campus, Imperial College London, London W12 0NN, UK
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Vennik J, Hughes S, Smith KA, Misurya P, Bostock J, Howick J, Mallen C, Little P, Ratnapalan M, Lyness E, Dambha-Miller H, Morrison L, Leydon G, Everitt H, Bishop FL. Patient and practitioner priorities and concerns about primary healthcare interactions for osteoarthritis: A meta-ethnography. Patient Educ Couns 2022; 105:1865-1877. [PMID: 35125208 DOI: 10.1016/j.pec.2022.01.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 11/10/2021] [Accepted: 01/21/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVE To explore primary care practitioners' (PCPs) and patients' priorities and concerns for healthcare interactions for osteoarthritis (OA) in primary care. METHODS We searched Embase, CINAHL, Medline, PsychInfo (1990 to present) for primary qualitative and mixed methods studies with findings concerning healthcare interactions for OA symptoms. Patient and PCP perceptions were analysed separately then inter-related using a 'line of argument' synthesis. RESULTS Twenty-six studies reporting qualitative data from 557 patients and 199 PCPs were synthesised. Our findings suggest that therapeutic interactions for OA can be based on discordant priorities and concerns; some patients perceive that PCPs hold negative attitudes about OA and feel their concerns about impact are not appreciated; some PCPs feel patients have misconceptions about prognosis, and hold pessimistic views about outcomes; and both tend to de-prioritise OA within consultations. CONCLUSION Greater working in partnership could build mutual trust, facilitate tailored provision of information, and foster a shared understanding of OA upon which to build realistic goals for management. PRACTICE IMPLICATIONS Developing a better shared understanding of OA has the potential to improve the quality of healthcare interactions for both patients and PCPs. The significant impact of OA on everyday life means it should be given higher priority in primary care consultations.
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Affiliation(s)
- Jane Vennik
- Primary Care, Population Sciences and Medical Education, University of Southampton, Southampton, UK.
| | - Stephanie Hughes
- Primary Care, Population Sciences and Medical Education, University of Southampton, Southampton, UK
| | - Kirsten A Smith
- Primary Care, Population Sciences and Medical Education, University of Southampton, Southampton, UK
| | - Pranati Misurya
- Primary Care, Population Sciences and Medical Education, University of Southampton, Southampton, UK
| | | | - Jeremy Howick
- Faculty of Philosophy, University of Oxford, Oxford, UK
| | - Christian Mallen
- School of Primary, Community and Social Care, Keele University, Keele, UK
| | - Paul Little
- Primary Care, Population Sciences and Medical Education, University of Southampton, Southampton, UK
| | - Mohana Ratnapalan
- Primary Care, Population Sciences and Medical Education, University of Southampton, Southampton, UK
| | - Emily Lyness
- Primary Care, Population Sciences and Medical Education, University of Southampton, Southampton, UK
| | - Hajira Dambha-Miller
- Primary Care, Population Sciences and Medical Education, University of Southampton, Southampton, UK
| | - Leanne Morrison
- Centre for Clinical and Community Applications of Health Psychology, University of Southampton, Southampton, UK
| | - Geraldine Leydon
- Primary Care, Population Sciences and Medical Education, University of Southampton, Southampton, UK
| | - Hazel Everitt
- Primary Care, Population Sciences and Medical Education, University of Southampton, Southampton, UK
| | - Felicity L Bishop
- Centre for Clinical and Community Applications of Health Psychology, University of Southampton, Southampton, UK
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10
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Paskins Z, Farmer CE, Jones RK, Clark A, Troeberg L, Pandit H, Richardson SM, Loughlin J, Brown CA, Taylor EJ, Le Maitre CL, Wilcox RK, Bishop FL, Salt E, Clark EM, Andersson DA, McCarron M, Mason DJ, Wilkinson CM, Barlow T, Peat GM, Watt FE. P100 Research priorities to reduce the impact of musculoskeletal disorders. Rheumatology (Oxford) 2022. [DOI: 10.1093/rheumatology/keac133.099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background/Aims
Involving research users in setting priorities for research is essential to ensure research outcomes are patient-centred and to maximise research value and impact. In 2019, Versus Arthritis convened a Musculoskeletal Disorders (MSKD) Research Advisory Group (RAG) which included 25 members: people with musculoskeletal conditions, researchers and healthcare professionals. The RAG identified a need for a research prioritisation exercise for adult non-inflammatory MSKD.
Methods
The Child Health and Nutrition Research Initiative (CHNRI) method was selected. The MSKD RAG identified, through consensus, four research Domains: Mechanisms of Disease; Diagnosis and Impact; Living Well with MSK disorders and Successful Translation. Following ethical approval, an initial electronic survey was distributed to stakeholders (people with musculoskeletal conditions, researchers, healthcare professionals, industry, research funders, healthcare providers, government and charities) asking for important research uncertainties in the four domains. Uncertainties were organised into themes and refined into research questions using a series of MSKD RAG workshops. Research questions underwent lay review to optimise readability. A second e-survey was distributed to stakeholders as above, where participants were asked to score each research question for two criteria, importance and impact, on a 1-10 numeric rating scale. Median criterion scores for impact and importance were calculated for each question and summed to create a total score. Research questions were ranked according to total score.
Results
The first survey had 209 respondents, who described 1290 research uncertainties, which were refined into 68 research questions. 285 people responded to the second survey, of which 189 fully completed. 74(39.2%) were public/lay responders, 48(25.4%) researchers, 43(22.8%) clinicians, 24(12.6%) other/unrecorded. The research questions, total scores and rankings are summarised in Table 1. Total scores ranged from 12 to 18 (maximum possible score 20).
Conclusion
For the first time, we have summarised priorities for research across MSKD, from discovery science to applied clinical and health research, including translation. Key priorities include developing and testing new treatments, better targeting of treatments, early diagnosis, prevention and better understanding and management of pain, with an emphasis on understanding the underpinning mechanisms. We present a call to action to researchers and funders to target these priorities.
Disclosure
Z. Paskins: Grants/research support; NIHR, Versus Arthritis, Royal Osteoporosis Society. C.E. Farmer: None. R.K. Jones: None. A. Clark: None. L. Troeberg: Grants/research support; Versus Arthritis. H. Pandit: Consultancies; Depuy J&J, Zimmer Biomet, Smith and Nephew, Medacta International, Meril Life, JRI Orthopaedics, Invibio and Kennedy’s Law. Grants/research support; NIHR, VA (Versus Arthritis) and UKIERI (UK India Education and Research Initiative). S.M. Richardson: None. J. Loughlin: None. C.A. Brown: Grants/research support; Versus Arthrtitis. E.J. Taylor: None. C.L. Le Maitre: None. R.K. Wilcox: Grants/research support; EPSRC, Versus Arthritis, NIHR, DePuy Synthes. F.L. Bishop: None. E. Salt: None. E.M. Clark: Grants/research support; Versus Arthritis, NIHR. Other; I am Associate Editor of Journal of Bone and Mineral Research Plus for which I receive a salary, I am part of the Lot 2 provider for analysis of the national Joint Registry of England and Wales, funded by HQIP. D.A. Andersson: None. M. McCarron: None. D.J. Mason: None. C.M. Wilkinson: None. T. Barlow: None. G.M. Peat: None. F.E. Watt: Consultancies; Pfizer.
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Affiliation(s)
- Zoe Paskins
- School of Medicine, Keele University, Keele, UNITED KINGDOM
| | | | - Richard K Jones
- Centre for Health Sciences Research, University of Salford, Manchester, UNITED KINGDOM
| | - Amanda Clark
- Versus Arthritis, Versus Arthritis, Chesterfield, UNITED KINGDOM
| | - Linda Troeberg
- Norwich Medical School, University of East Anglia, Norwich, UNITED KINGDOM
| | - Hemant Pandit
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UNITED KINGDOM
| | - Stephen M Richardson
- School of Biological Sciences, University of Manchester, Manchester, UNITED KINGDOM
| | - John Loughlin
- Biosciences Institute, Newcastle University, Newcastle upon Tyne, UNITED KINGDOM
| | - Christopher A Brown
- Department of Psychology, University of Liverpool, Liverpool, UNITED KINGDOM
| | | | - Christine L Le Maitre
- Biomedical Sciences Research Centre, Sheffield Hallam University, Sheffield, UNITED KINGDOM
| | - Ruth K Wilcox
- Institute of Medical and Biological Engineering, University of Leeds, Leeds, UNITED KINGDOM
| | - Felicity L Bishop
- School of Psychology, University of Southampton, Southampton, UNITED KINGDOM
| | - Emma Salt
- Physiotherapy Department, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UNITED KINGDOM
| | - Emma M Clark
- Translational health Sciences, University of Bristol, Bristol, UNITED KINGDOM
| | | | - Maura McCarron
- Rheumatology, Belfast Health and Social Care Trust, Belfast, UNITED KINGDOM
| | - Deborah J Mason
- School of Biosciences, Cardiff University, Cardiff, UNITED KINGDOM
| | - Colin M Wilkinson
- Versus Arthritis, Versus Arthritis, Stockton-on-Tees, UNITED KINGDOM
| | - Timothy Barlow
- Orthopaedics, Wrightington Hospital, Wigan, UNITED KINGDOM
| | - George M Peat
- School of Medicine, Keele University, Keele, UNITED KINGDOM
| | - Fiona E Watt
- Department of Immunology and Inflammation, Imperial College, London, UNITED KINGDOM
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11
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Beard DJ, Campbell MK, Blazeby JM, Carr AJ, Weijer C, Cuthbertson BH, Buchbinder R, Pinkney T, Bishop FL, Pugh J, Cousins S, Harris I, Lohmander LS, Blencowe N, Gillies K, Probst P, Brennan C, Cook A, Farrar-Hockley D, Savulescu J, Huxtable R, Rangan A, Tracey I, Brocklehurst P, Ferreira ML, Nicholl J, Reeves BC, Hamdy F, Rowley SC, Lee N, Cook JA. Placebo comparator group selection and use in surgical trials: the ASPIRE project including expert workshop. Health Technol Assess 2021; 25:1-52. [PMID: 34505829 PMCID: PMC8450778 DOI: 10.3310/hta25530] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND The use of placebo comparisons for randomised trials assessing the efficacy of surgical interventions is increasingly being considered. However, a placebo control is a complex type of comparison group in the surgical setting and, although powerful, presents many challenges. OBJECTIVES To provide a summary of knowledge on placebo controls in surgical trials and to summarise any recommendations for designers, evaluators and funders of placebo-controlled surgical trials. DESIGN To carry out a state-of-the-art workshop and produce a corresponding report involving key stakeholders throughout. SETTING A workshop to discuss and summarise the existing knowledge and to develop the new guidelines. RESULTS To assess what a placebo control entails and to assess the understanding of this tool in the context of surgery is considered, along with when placebo controls in surgery are acceptable (and when they are desirable). We have considered ethics arguments and regulatory requirements, how a placebo control should be designed, how to identify and mitigate risk for participants in these trials, and how such trials should be carried out and interpreted. The use of placebo controls is justified in randomised controlled trials of surgical interventions provided that there is a strong scientific and ethics rationale. Surgical placebos might be most appropriate when there is poor evidence for the efficacy of the procedure and a justified concern that results of a trial would be associated with a high risk of bias, particularly because of the placebo effect. CONCLUSIONS The use of placebo controls is justified in randomised controlled trials of surgical interventions provided that there is a strong scientific and ethics rationale. Feasibility work is recommended to optimise the design and implementation of randomised controlled trials. An outline for best practice was produced in the form of the Applying Surgical Placebo in Randomised Evaluations (ASPIRE) guidelines for those considering the use of a placebo control in a surgical randomised controlled trial. LIMITATIONS Although the workshop participants involved international members, the majority of participants were from the UK. Therefore, although every attempt was made to make the recommendations applicable to all health systems, the guidelines may, unconsciously, be particularly applicable to clinical practice in the UK NHS. FUTURE WORK Future work should evaluate the use of the ASPIRE guidelines in making decisions about the use of a placebo-controlled surgical trial. In addition, further work is required on the appropriate nomenclature to adopt in this space. FUNDING Funded by the Medical Research Council UK and the National Institute for Health Research as part of the Medical Research Council-National Institute for Health Research Methodology Research programme.
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Affiliation(s)
- David J Beard
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | | | - Jane M Blazeby
- Centre for Surgical Research, NIHR Bristol and Weston Biomedical Research Centre, Population Health Sciences, University of Bristol, Bristol, UK
| | - Andrew J Carr
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Charles Weijer
- Departments of Medicine, Epidemiology and Biostatistics, and Philosophy, Western University, London, ON, Canada
| | - Brian H Cuthbertson
- Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Rachelle Buchbinder
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Thomas Pinkney
- Academic Department of Surgery, University of Birmingham, Queen Elizabeth Hospital Birmingham, Birmingham, UK
| | - Felicity L Bishop
- Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK
| | - Jonathan Pugh
- The Oxford Uehiro Centre for Practical Ethics, University of Oxford, Oxford, UK
| | - Sian Cousins
- Centre for Surgical Research, NIHR Bristol and Weston Biomedical Research Centre, Population Health Sciences, University of Bristol, Bristol, UK
| | - Ian Harris
- Faculty of Medicine, South Western Sydney Clinical School, University of New South Wales, Sydney, NSW, Australia
| | - L Stefan Lohmander
- Department of Clinical Sciences Lund, Orthopedics, Clinical Epidemiology Unit, Lund University, Lund, Sweden
| | - Natalie Blencowe
- Centre for Surgical Research, NIHR Bristol and Weston Biomedical Research Centre, Population Health Sciences, University of Bristol, Bristol, UK
| | - Katie Gillies
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Pascal Probst
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
| | | | - Andrew Cook
- Wessex Institute, University of Southampton, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | | | - Julian Savulescu
- The Oxford Uehiro Centre for Practical Ethics, University of Oxford, Oxford, UK
| | - Richard Huxtable
- Centre for Surgical Research, NIHR Bristol and Weston Biomedical Research Centre, Population Health Sciences, University of Bristol, Bristol, UK
| | - Amar Rangan
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
- Department of Health Sciences, University of York, York, UK
| | - Irene Tracey
- Nuffield Department of Clinical Neurosciences, University of Oxford, John Radcliffe Hospital, Oxford, UK
| | - Peter Brocklehurst
- Birmingham Clinical Trials Unit, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Manuela L Ferreira
- Faculty of Medicine and Health, Institute of Bone and Joint Research, Northern Clinical School, The University of Sydney, Sydney, NSW, Australia
| | - Jon Nicholl
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Barnaby C Reeves
- Clinical Trials Evaluation Unit Bristol Medical School, University of Bristol, Bristol Royal Infirmary, Bristol, UK
| | - Freddie Hamdy
- Nuffield Department of Surgical Sciences, University of Oxford, John Radcliffe Hospital, Oxford, UK
| | | | - Naomi Lee
- Editorial Department, The Lancet, London, UK
| | - Jonathan A Cook
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
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12
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Smith KA, Vennik J, Morrison L, Hughes S, Steele M, Tiwari R, Bostock J, Howick J, Mallen C, Little P, Ratnapalan M, Lyness E, Misurya P, Leydon GM, Dambha-Miller H, Everitt HA, Bishop FL. Harnessing Placebo Effects in Primary Care: Using the Person-Based Approach to Develop an Online Intervention to Enhance Practitioners' Communication of Clinical Empathy and Realistic Optimism During Consultations. Front Pain Res (Lausanne) 2021; 2:721222. [PMID: 35295512 PMCID: PMC8915751 DOI: 10.3389/fpain.2021.721222] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Accepted: 07/26/2021] [Indexed: 12/30/2022] Open
Abstract
Background: Empathic communication and positive messages are important components of "placebo" effects and can improve patient outcomes, including pain. Communicating empathy and optimism to patients within consultations may also enhance the effects of verum, i.e., non-placebo, treatments. This is particularly relevant for osteoarthritis, which is common, costly and difficult to manage. Digital interventions can be effective tools for changing practitioner behavior. This paper describes the systematic planning, development and optimization of an online intervention-"Empathico"-to help primary healthcare practitioners enhance their communication of clinical empathy and realistic optimism during consultations. Methods: The Person-Based Approach to intervention development was used. This entailed integrating insights from placebo and behavior change theory and evidence, and conducting primary and secondary qualitative research. Systematic literature reviews identified barriers, facilitators, and promising methods for enhancing clinical empathy and realistic optimism. Qualitative studies explored practitioners' and patients' perspectives, initially on the communication of clinical empathy and realistic optimism and subsequently on different iterations of the Empathico intervention. Insights from the literature reviews, qualitative studies and public contributor input were integrated into a logic model, behavioral analysis and principles that guided intervention development and optimization. Results: The Empathico intervention comprises 7 sections: Introduction, Empathy, Optimism, Application of Empathico for Osteoarthritis, Reflection on my Consultations, Setting Goals and Further Resources. Iterative refinement of Empathico, using feedback from patients and practitioners, resulted in highly positive feedback and helped to (1) contextualize evidence-based recommendations from placebo studies within the complexities of primary healthcare consultations and (2) ensure the intervention addressed practitioners' and patients' concerns and priorities. Conclusions: We have developed an evidence-based, theoretically-grounded intervention that should enable practitioners to better harness placebo effects of communication in consultations. The extensive use of qualitative research throughout the development and optimization process ensured that Empathico is highly acceptable and meaningful to practitioners. This means that practitioners are more likely to engage with Empathico and make changes to enhance their communication of clinical empathy and realistic optimism in clinical practice. Empathico is now ready to be evaluated in a large-scale randomized trial to explore its impact on patient outcomes.
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Affiliation(s)
- Kirsten A. Smith
- Primary Care Population Sciences and Medical Education, University of Southampton, Southampton, United Kingdom
| | - Jane Vennik
- Primary Care Population Sciences and Medical Education, University of Southampton, Southampton, United Kingdom
| | - Leanne Morrison
- Primary Care Population Sciences and Medical Education, University of Southampton, Southampton, United Kingdom
- Centre for Clinical and Community Applications of Health Psychology, Department of Psychology, University of Southampton, Southampton, United Kingdom
| | - Stephanie Hughes
- Primary Care Population Sciences and Medical Education, University of Southampton, Southampton, United Kingdom
| | - Mary Steele
- Primary Care Population Sciences and Medical Education, University of Southampton, Southampton, United Kingdom
| | - Riya Tiwari
- Primary Care Population Sciences and Medical Education, University of Southampton, Southampton, United Kingdom
- Centre for Clinical and Community Applications of Health Psychology, Department of Psychology, University of Southampton, Southampton, United Kingdom
| | - Jennifer Bostock
- Policy Innovation & Evaluation Research Unit, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Jeremy Howick
- Faculty of Philosophy, University of Oxford, Oxford, United Kingdom
| | - Christian Mallen
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Keele, United Kingdom
| | - Paul Little
- Primary Care Population Sciences and Medical Education, University of Southampton, Southampton, United Kingdom
| | - Mohana Ratnapalan
- Primary Care Population Sciences and Medical Education, University of Southampton, Southampton, United Kingdom
| | - Emily Lyness
- Primary Care Population Sciences and Medical Education, University of Southampton, Southampton, United Kingdom
| | - Pranati Misurya
- Centre for Clinical and Community Applications of Health Psychology, Department of Psychology, University of Southampton, Southampton, United Kingdom
| | - Geraldine M. Leydon
- Primary Care Population Sciences and Medical Education, University of Southampton, Southampton, United Kingdom
| | - Hajira Dambha-Miller
- Primary Care Population Sciences and Medical Education, University of Southampton, Southampton, United Kingdom
| | - Hazel A. Everitt
- Primary Care Population Sciences and Medical Education, University of Southampton, Southampton, United Kingdom
| | - Felicity L. Bishop
- Centre for Clinical and Community Applications of Health Psychology, Department of Psychology, University of Southampton, Southampton, United Kingdom
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13
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Williams CE, Hadwin JA, Bishop FL. Primary teachers’ experiences of teaching pupils with selective mutism: a grounded theory study. Educational Psychology in Practice 2021. [DOI: 10.1080/02667363.2021.1920372] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Claire E. Williams
- Brighton and Hove Educational Psychology Service, Brighton and Hove Inclusion Support Service, Brighton, UK
| | - Julie A. Hadwin
- Childhood Research Forum, Centre for Education and Policy Analysis (CEPA), School of Education, Liverpool Hope University, Liverpool, UK
| | - Felicity L. Bishop
- Centre for Clinical and Community Applications of Health Psychology, School of Psychology, University of Southampton, Southampton, UK
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14
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Pinto JW, Bradbury K, Newell D, Bishop FL. Lifestyle and Health Behavior Change in Traditional Acupuncture Practice: A Systematic Critical Interpretive Synthesis. J Altern Complement Med 2020; 27:238-254. [PMID: 33332183 DOI: 10.1089/acm.2020.0365] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Introduction: Behavioral factors are the leading cause of ill-health worldwide. Diet, physical activity, smoking, and alcohol consumption are the focus of public health targets on promotion of healthy behavior. The science of behavior change is rapidly growing and has largely evolved within mainstream health care treatments. Traditional Chinese Medicine includes self-care practices that encourage healthy behavior alongside treatments such as acupuncture. Exploring behavior change within traditional acupuncture could potentially highlight new techniques and approaches, and contribute to developing models of behavior change. Aims: In this review, the authors aimed to critically appraise research exploring health behavior change within traditional acupuncture, to highlight gaps in the field, identify questions, and enable theory development. Design/Method: The authors were guided by a critical interpretive synthesis (CIS) method to explore a diverse mixture of research including qualitative and quantitative articles. Eight databases were searched up to October 2017 for articles published in English. Eleven thousand four hundred eighty-eight articles were identified (7,149 after deduplication). Titles and abstracts were screened by one reviewer (10% by a second reviewer). Eligible articles were selected using a Population, Intervention, Comparison, Outcome framework. CIS methods, including purposive sampling of eligible articles and a reflexive, dialectic process of critiquing evidence and theory, were used to synthesize the evidence. Results: Several articles examined the prevalence and patterns of behavior change and support for change, although methods varied and reliability of results was limited. There was more evidence concerning diet/exercise than alcohol/smoking. Aspects of acupuncturists' work identified as potential key elements for promoting behavior change included: individualized advice based on symptoms; holistic/biopsychosocial explanations; therapeutic relationship; simultaneous treatment of behavior-limiting symptoms; and patients' physical involvement with intervention. A logic model of the process of behavior change was developed, proposing that perceived support, mutual understanding, and active participation may facilitate change. Possible moderators included: single/multicomponent acupuncture; setting; patient/practitioner characteristics; treatment experience; timing; and treatment duration. Conclusion: These findings suggest behavior change work is a significant part of traditional acupuncture practice, although more reliable evidence is needed to understand the effectiveness, prevalence, and patterns of this work (in particular the patterns suggesting acupuncturists are more likely to work on changes to diet and physical activity than alcohol and smoking behaviors, and more likely to support changes in long-term compared with acute conditions). The proposed model of behavior change should be developed and tested with a view to refining the model and elaborating the suggested links with a wider theory of behavior and behavior change. This review was preregistered with PROSPERO as "Health behaviour change in traditional acupuncture treatment: a protocol for a critical interpretive synthesis": CRD42018099766.
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Affiliation(s)
- Jonquil W Pinto
- Department of Psychology, Faculty of Environmental & Life Sciences, University of Southampton, Highfield Campus, Southampton, United Kingdom
| | - Kat Bradbury
- Department of Psychology, Faculty of Environmental & Life Sciences, University of Southampton, Highfield Campus, Southampton, United Kingdom
| | - Dave Newell
- Faculty of Medicine, University of Southampton, Highfield Campus, Southampton, United Kingdom.,AECC University College, Bournemouth, United Kingdom
| | - Felicity L Bishop
- Department of Psychology, Faculty of Environmental & Life Sciences, University of Southampton, Highfield Campus, Southampton, United Kingdom
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15
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Hughes S, Sibelli A, Everitt HA, Moss-Morris R, Chalder T, Harvey JM, Vas Falcao A, Landau S, O'Reilly G, Windgassen S, Holland R, Little P, McCrone P, Goldsmith K, Coleman N, Logan R, Bishop FL. Patients' Experiences of Telephone-Based and Web-Based Cognitive Behavioral Therapy for Irritable Bowel Syndrome: Longitudinal Qualitative Study. J Med Internet Res 2020; 22:e18691. [PMID: 33216002 PMCID: PMC7718092 DOI: 10.2196/18691] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 06/24/2020] [Accepted: 07/26/2020] [Indexed: 12/23/2022] Open
Abstract
Background Cognitive behavioral therapy (CBT) is recommended in guidelines for people with refractory irritable bowel syndrome (IBS). However, the availability of CBT is limited, and poor adherence has been reported in face-to-face CBT. Objective Nested within a randomized controlled trial of telephone- and web-delivered CBT for refractory IBS, this qualitative study aims to identify barriers to and facilitators of engagement over time with the interventions, identify social and psychological processes of change, and provide insight into trial results. Methods A longitudinal qualitative study was nested in a randomized controlled trial. Repeated semistructured interviews were conducted at 3 (n=34) and 12 months (n=25) post baseline. Participants received telephone-based CBT (TCBT; n=17 at 3 months and n=13 at 12 months) or web-based CBT (WCBT; n=17 at 3 months and n=12 at 12 months). Inductive thematic analysis was used to analyze the data. Results Participants viewed CBT as credible for IBS, perceived their therapists as knowledgeable and supportive, and liked the flexibility of web-based and telephone-based delivery; these factors facilitated engagement. Potential barriers to engagement in both groups (mostly overcome by our participants) included initial skepticism and concerns about the biopsychosocial nature of CBT, initial concerns about telephone-delivered talking therapy, challenges of maintaining motivation and self-discipline given already busy lives, and finding nothing new in the WCBT (WCBT group only). Participants described helpful changes in their understanding of IBS, attitudes toward IBS, ability to recognize IBS patterns, and IBS-related behaviors. Consistent with the trial results, participants described lasting positive effects on their symptoms, work, and social lives. Reasons and remedies for some attenuation of effects were identified. Conclusions Both TCBT and WCBT for IBS were positively received and had lasting positive impacts on participants’ understanding of IBS, IBS-related behaviors, symptoms, and quality of life. These forms of CBT may broaden access to CBT for IBS.
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Affiliation(s)
- Stephanie Hughes
- Centre for Clinical and Community Applications of Health Psychology, Department of Psychology, University of Southampton, Southampton, United Kingdom
| | - Alice Sibelli
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Hazel A Everitt
- Centre for Clinical and Community Applications of Health Psychology, Department of Psychology, University of Southampton, Southampton, United Kingdom
| | - Rona Moss-Morris
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Trudie Chalder
- Academic Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - J Matthew Harvey
- Centre for Clinical and Community Applications of Health Psychology, Department of Psychology, University of Southampton, Southampton, United Kingdom
| | - Andrea Vas Falcao
- Centre for Clinical and Community Applications of Health Psychology, Department of Psychology, University of Southampton, Southampton, United Kingdom
| | - Sabine Landau
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Gilly O'Reilly
- Centre for Clinical and Community Applications of Health Psychology, Department of Psychology, University of Southampton, Southampton, United Kingdom
| | - Sula Windgassen
- Academic Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Rachel Holland
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Paul Little
- Centre for Clinical and Community Applications of Health Psychology, Department of Psychology, University of Southampton, Southampton, United Kingdom
| | - Paul McCrone
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Kimberley Goldsmith
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Nicholas Coleman
- Department of Gastroenterology, Southampton University Hospital, Southampton, United Kingdom
| | | | - Felicity L Bishop
- Centre for Clinical and Community Applications of Health Psychology, Department of Psychology, University of Southampton, Southampton, United Kingdom
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Smith KA, Bishop FL, Dambha-Miller H, Ratnapalan M, Lyness E, Vennik J, Hughes S, Bostock J, Morrison L, Mallen C, Yardley L, Everitt H, Little P, Howick J. Improving Empathy in Healthcare Consultations-a Secondary Analysis of Interventions. J Gen Intern Med 2020; 35:3007-3014. [PMID: 32666488 PMCID: PMC7572919 DOI: 10.1007/s11606-020-05994-w] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Accepted: 06/15/2020] [Indexed: 11/25/2022]
Abstract
A recent systematic review of randomised trials suggested that empathic communication improves patient health outcomes. However, the methods for training healthcare practitioners (medical professionals; HCPs) in empathy and the empathic behaviours demonstrated within the trials were heterogeneous, making the evidence difficult to implement in routine clinical practice. In this secondary analysis of seven trials in the review, we aimed to identify (1) the methods used to train HCPs, (2) the empathy behaviours they were trained to perform and (3) behaviour change techniques (BCTs) used to encourage the adoption of those behaviours. This detailed understanding of interventions is necessary to inform implementation in clinical practice. We conducted a content analysis of intervention descriptions, using an inductive approach to identify training methods and empathy behaviours and a deductive approach to describe the BCTs used. The most commonly used methods to train HCPs to enhance empathy were face-to-face training (n = 5), role-playing (n = 3) and videos (self or model; n = 3). Duration of training was varied, with both long and short training having high effect sizes. The most frequently targeted empathy behaviours were providing explanations of treatment (n = 5), providing non-specific empathic responses (e.g. expressing understanding) and displaying a friendly manner and using non-verbal behaviours (e.g. nodding, leaning forward, n = 4). The BCT most used to encourage HCPs to adopt empathy behaviours was "Instruction on how to perform behaviour" (e.g. a video demonstration, n = 5), followed by "Credible source" (e.g. delivered by a psychologist, n = 4) and "Behavioural practice" (n = 3 e.g. role-playing). We compared the effect sizes of studies but could not extrapolate meaningful conclusions due to high levels of variation in training methods, empathy skills and BCTs. Moreover, the methods used to train HCPs were often poorly described which limits study replication and clinical implementation. This analysis of empathy training can inform future research, intervention reporting standards and clinical practice.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Lucy Yardley
- University of Southampton , Southampton, UK
- University of Bristol , Bristol, UK
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Everitt H, Landau S, Little P, Bishop FL, O'Reilly G, Sibelli A, Holland R, Hughes S, Windgassen S, McCrone P, Goldsmith K, Coleman N, Logan R, Chalder T, Moss-Morris R. Therapist telephone-delivered CBT and web-based CBT compared with treatment as usual in refractory irritable bowel syndrome: the ACTIB three-arm RCT. Health Technol Assess 2020; 23:1-154. [PMID: 31042143 DOI: 10.3310/hta23170] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Irritable bowel syndrome (IBS) affects 10-22% of people in the UK. Abdominal pain, bloating and altered bowel habits affect quality of life and can lead to time off work. Current treatment relies on a positive diagnosis, reassurance, lifestyle advice and drug therapies, but many people suffer ongoing symptoms. Cognitive-behavioural therapy (CBT) is recommended in guidelines for patients with ongoing symptoms but its availability is limited. OBJECTIVES To determine the clinical effectiveness and cost-effectiveness of therapist telephone-delivered CBT (TCBT) and web-based CBT (WCBT) with minimal therapist support compared with treatment as usual (TAU) in refractory IBS. DESIGN This was a three-arm randomised controlled trial. SETTING This trial took place in UK primary and secondary care. PARTICIPANTS Adults with refractory IBS (clinically significant symptoms for 12 months despite first-line therapies) were recruited from 74 general practices and three gastroenterology centres from May 2014 to March 2016. INTERVENTIONS TCBT - patient CBT self-management manual, six 60-minute telephone sessions over 9 weeks and two 60-minute booster sessions at 4 and 8 months (8 hours' therapist time). WCBT - interactive, tailored web-based CBT, three 30-minute telephone sessions over 9 weeks and two 30-minute boosters at 4 and 8 months (2.5 hours' therapist time). MAIN OUTCOME MEASURES Primary outcomes - IBS symptom severity score (IBS SSS) and Work and Social Adjustment Scale (WSAS) at 12 months. Cost-effectiveness [quality-adjusted life-years (QALYs) and health-care costs]. RESULTS In total, 558 out of 1452 patients (38.4%) screened for eligibility were recruited - 186 were randomised to TCBT, 185 were randomised to WCBT and 187 were randomised to TAU. The mean baseline Irritable Bowel Syndrome Symptom Severity Score (IBS SSS) was 265.0. An intention-to-treat analysis with multiple imputation was carried out at 12 months; IBS SSS were 61.6 points lower in the TCBT arm [95% confidence interval (CI) 89.5 to 33.8; p < 0.001] and 35.2 points lower in the WCBT arm (95% CI 57.8 to 12.6; p = 0.002) than in the TAU arm (IBS SSS of 205.6). The mean WSAS score at 12 months was 10.8 in the TAU arm, 3.5 points lower in the TCBT arm (95% CI 5.1 to 1.9; p < 0.001) and 3.0 points lower in the WCBT arm (95% CI 4.6 to 1.3; p = 0.001). For the secondary outcomes, the Subject's Global Assessment showed an improvement in symptoms at 12 months (responders) in 84.8% of the TCBT arm compared with 41.7% of the TAU arm [odds ratio (OR) 6.1, 95% CI 2.5 to 15.0; p < 0.001] and 75.0% of the WCBT arm (OR 3.6, 95% CI 2.0 to 6.3; p < 0.001). Patient enablement was 78.3% (responders) for TCBT, 23.5% for TAU (OR 9.3, 95% CI 4.5 to 19.3; p < 0.001) and 54.8% for WCBT (OR 3.5, 95% CI 2.0 to 5.9; p < 0.001). Adverse events were similar between the trial arms. The incremental cost-effectiveness ratio (ICER) (QALY) for TCBT versus TAU was £22,284 and for WCBT versus TAU was £7724. Cost-effectiveness reduced after imputation for missing values. Qualitative findings highlighted that, in the CBT arms, there was increased capacity to cope with symptoms, negative emotions and challenges of daily life. Therapist input was important in supporting WCBT. CONCLUSIONS In this large, rigorously conducted RCT, both CBT arms showed significant improvements in IBS outcomes compared with TAU. WCBT had lower costs per QALY than TCBT. Sustained improvements in IBS symptoms are possible at an acceptable cost. Suggested future research work is longer-term follow-up and research to translate these findings into usual clinical practice. FUTURE WORK Longer-term follow-up and research to translate these findings into usual clinical practice is needed. TRIAL REGISTRATION Current Controlled Trials ISRCTN44427879. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment (HTA) programme and will be published in full in Health Technology Assessment; Vol. 23, No. 17. See the NIHR Journals Library website for further project information. The University of Southampton sponsored this study. Funding was received from the NIHR HTA Board and the NIHR Clinical Research Network and support was received from the NIHR Clinical Research Network.
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Affiliation(s)
- Hazel Everitt
- Primary Care and Population Sciences, University of Southampton, Southampton, UK
| | - Sabine Landau
- Biostatistics, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Paul Little
- Primary Care and Population Sciences, University of Southampton, Southampton, UK
| | - Felicity L Bishop
- Centre for Applications of Health Psychology, University of Southampton, Southampton, UK
| | - Gillian O'Reilly
- Primary Care and Population Sciences, University of Southampton, Southampton, UK
| | - Alice Sibelli
- Health Psychology Section, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Rachel Holland
- Biostatistics, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Stephanie Hughes
- Primary Care and Population Sciences, University of Southampton, Southampton, UK
| | - Sula Windgassen
- Health Psychology Section, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Paul McCrone
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Kim Goldsmith
- Biostatistics, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Nicholas Coleman
- Department of Gastroenterology, Southampton University Hospital, Southampton, UK
| | - Robert Logan
- Department of Gastroenterology, King's College Hospital, London, UK
| | - Trudie Chalder
- Academic Department of Psychological Medicine, King's College London, London, UK
| | - Rona Moss-Morris
- Health Psychology Section, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
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Beard DJ, Campbell MK, Blazeby JM, Carr AJ, Weijer C, Cuthbertson BH, Buchbinder R, Pinkney T, Bishop FL, Pugh J, Cousins S, Harris IA, Lohmander LS, Blencowe N, Gillies K, Probst P, Brennan C, Cook A, Farrar-Hockley D, Savulescu J, Huxtable R, Rangan A, Tracey I, Brocklehurst P, Ferreira ML, Nicholl J, Reeves BC, Hamdy F, Rowley SC, Cook JA. Considerations and methods for placebo controls in surgical trials (ASPIRE guidelines). Lancet 2020; 395:828-838. [PMID: 32145797 DOI: 10.1016/s0140-6736(19)33137-x] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Revised: 11/13/2019] [Accepted: 12/06/2019] [Indexed: 01/09/2023]
Abstract
Placebo comparisons are increasingly being considered for randomised trials assessing the efficacy of surgical interventions. The aim of this Review is to provide a summary of knowledge on placebo controls in surgical trials. A placebo control is a complex type of comparison group in the surgical setting and, although powerful, presents many challenges. This Review outlines what a placebo control entails and present understanding of this tool in the context of surgery. We consider when placebo controls in surgery are acceptable (and when they are desirable) in terms of ethical arguments and regulatory requirements, how a placebo control should be designed, how to identify and mitigate risk for participants in these trials, and how such trials should be done and interpreted. Use of placebo controls is justified in randomised controlled trials of surgical interventions provided there is a strong scientific and ethical rationale. Surgical placebos might be most appropriate when there is poor evidence for the efficacy of the procedure and a justified concern that results of a trial would be associated with high risk of bias, particularly because of the placebo effect. Feasibility work is recommended to optimise the design and implementation of randomised controlled trials. This Review forms an outline for best practice and provides guidance, in the form of the Applying Surgical Placebo in Randomised Evaluations (known as ASPIRE) checklist, for those considering the use of a placebo control in a surgical randomised controlled trial.
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Affiliation(s)
- David J Beard
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Botnar Research Centre, University of Oxford, Oxford, UK.
| | - Marion K Campbell
- Health Services Research Unit, Health Sciences Building, University of Aberdeen, Aberdeen, UK
| | - Jane M Blazeby
- Centre for Surgical Research Population Health Sciences, Beacon House, University of Bristol, Bristol
| | - Andrew J Carr
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Botnar Research Centre, University of Oxford, Oxford, UK
| | - Charles Weijer
- Rotman Institute of Philosophy, Western Interdisciplinary Research Building, Western University, London, ON, Canada
| | - Brian H Cuthbertson
- Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Rachelle Buchbinder
- Cabrini-Monash Department of Clinical Epidemiology, Cabrini Institute and Monash University, Melbourne, VIC, Australia
| | - Thomas Pinkney
- Academic Department of Surgery, Heritage Building, Queen Elizabeth Hospital Birmingham, University of Birmingham, Birmingham, UK
| | - Felicity L Bishop
- Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK
| | - Jonathan Pugh
- The Oxford Uehiro Centre for Practical Ethics, University of Oxford, Oxford, UK
| | - Sian Cousins
- Centre for Surgical Research Population Health Sciences, Beacon House, University of Bristol, Bristol
| | - Ian A Harris
- Ingham Institute for Applied Medical Research, South Western Sydney Clinical School, The University of New South Wales, Sydney, NSW, Australia
| | - L Stefan Lohmander
- Department of Clinical Sciences Lund, Department of Orthopaedics Lund, Lund University, Lund, Sweden
| | - Natalie Blencowe
- Centre for Surgical Research Population Health Sciences, Beacon House, University of Bristol, Bristol
| | - Katie Gillies
- Health Services Research Unit, Health Sciences Building, University of Aberdeen, Aberdeen, UK
| | - Pascal Probst
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
| | | | - Andrew Cook
- Wessex Institute, University of Southampton, Southampton, UK; University Hospital Southampton National Health Service Foundation Trust, Southampton, UK
| | | | - Julian Savulescu
- The Oxford Uehiro Centre for Practical Ethics, University of Oxford, Oxford, UK
| | - Richard Huxtable
- Centre for Surgical Research Population Health Sciences, Beacon House, University of Bristol, Bristol
| | - Amar Rangan
- Department of Health Sciences, Seebohm Rowntree Building, University of York, York, UK
| | - Irene Tracey
- Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford, UK
| | - Peter Brocklehurst
- Birmingham Clinical Trials Unit, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Manuela L Ferreira
- Faculty of Medicine and Health, Institute of Bone and Joint Research, Northern Clinical School, University of Sydney, Sydney, NSW, Australia
| | - Jon Nicholl
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | | | - Freddie Hamdy
- Nuffield Department of Surgical Sciences, John Radcliffe Hospital, University of Oxford, Oxford, UK; Old Road Campus Research Building, University of Oxford, Oxford, UK
| | | | - Jonathan A Cook
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Botnar Research Centre, University of Oxford, Oxford, UK
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Ratnapalan M, Coghlan B, Tan M, Everitt H, Geraghty AWA, Little P, Lewith G, Bishop FL. Placebos in primary care? a nominal group study explicating UK GP and patient views of six theoretically plausible models of placebo practice. BMJ Open 2020; 10:e032524. [PMID: 32075826 PMCID: PMC7044897 DOI: 10.1136/bmjopen-2019-032524] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVES To better understand which theoretically plausible placebogenic techniques might be acceptable in UK primary care. DESIGN A qualitative study using nominal group technique and thematic analysis. Participants took part in audio-recorded face-to-face nominal groups in which the researcher presented six scenarios describing the application in primary care of theoretically plausible placebogenic techniques: (1) Withholding side effects information, (2) Monitoring, (3) General practitioner (GP) endorsement, (4) Idealised consultation, (5) Deceptive placebo pills and (6) Open-label placebo pills. Participants voted on whether they thought each scenario was acceptable in practice and discussed their reasoning. Votes were tallied and discussions transcribed verbatim. SETTING Primary care in England. PARTICIPANTS 21 GPs in four nominal groups and 20 'expert patients' in five nominal groups. RESULTS Participants found it hard to decide which practices were acceptable and spoke about needing to weigh potential symptomatic benefits against the potential harms of lost trust eroding the therapeutic relationship. Primary care patients and doctors felt it was acceptable to harness placebo effects in practice by patient self-monitoring (scenario 2), by the GP expressing a strongly positive belief in a therapy (scenario 3) and by conducting patient-centred, empathic consultations (scenario 4). Deceptive placebogenic practices (scenarios 1 and 5) were unacceptable to most groups. Patient and GP groups expressed a diverse range of opinions about open-label placebo pills. CONCLUSIONS Attempts to harness placebo effects in UK primary care are more likely to be accepted and implemented if they focus on enhancing positive patient-centred communication and empathic relationships. Using placebos deceptively is likely to be unacceptable to both GPs and patients. Open-label placebos also do not have clear support; they might be acceptable to some doctors and patients in very limited circumstances-but further evidence, clear information and guidance would be needed.
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Affiliation(s)
- Mohana Ratnapalan
- Primary Care and Population Sciences, University of Southampton, Southampton, UK
| | | | - Mengxin Tan
- Centre of Global Mental Health, London School of Hygiene and Tropical Medicine, London, London, UK
- Institute of Psychiatry, Psychology and Neuroscience, London, London, UK
| | - Hazel Everitt
- Primary Care and Population Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Adam W A Geraghty
- Primary Care and Population Sciences, University of Southampton, Southampton, UK
| | - Paul Little
- Primary Care and Population Sciences, University of Southampton, Southampton, UK
| | - George Lewith
- Primary Care and Population Sciences, University of Southampton, Southampton, UK
| | - Felicity L Bishop
- Primary Care and Population Sciences, University of Southampton, Southampton, UK
- Centre for Clinical and Community Applications of Health Psychology, University of Southampton, Southampton, UK
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Holmes MM, Stanescu S, Bishop FL. The Use of Measurement Systems to Support Patient Self-Management of Long-Term Conditions: An Overview of Opportunities and Challenges. Patient Relat Outcome Meas 2019; 10:385-394. [PMID: 31908555 PMCID: PMC6924578 DOI: 10.2147/prom.s178488] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Accepted: 11/27/2019] [Indexed: 12/30/2022]
Abstract
Long-term conditions are a major public health concern that present many challenges for patients living with them. There is increasing policy focus on promoting patient self-management and supporting patients to take ownership of managing their conditions. Because long term conditions often fluctuate over time, ongoing monitoring of disease activity is necessary for self-management; this can be achieved through using Patient Reported Outcome Measures (PROMs). PROMs can provide additional information about patients’ symptoms, functioning, and emotional wellbeing, informing clinical care for patients. Measurement systems are an innovative method to gather and report PROMs throughout a patient’s course of care, to support clinical practice and improve overall quality of care. Measurement systems are often delivered via a digital platform, which can convey patient-reported information to healthcare professionals and provide tailored self-management advice to patients, all based on information collected via PROMs. There are a number of potential benefits of this approach to self-management. Measurement systems can improve clinical practice, creating efficient clinical encounters and positively influencing patient-clinician interactions. The use of monitoring throughout a patient’s care is also thought to empower patients, by improving their knowledge of their condition, increasing their engagement with their health, and influencing their overall management of their condition. Challenges associated with using measurement systems in this way include finding appropriate PROMs, provisioning of suitable technology, and limiting the burden for patients. To increase the implementation of measurement systems into practice it is important to consider how to engage and educate healthcare professionals and patients to empower their use. Overall, adopting measurement systems into clinical practice may improve clinicians’ ability to support patient self-management of long-term conditions.
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Affiliation(s)
- Michelle M Holmes
- AECC University College, Bournemouth, Dorset, UK.,Department of Psychology, University of Southampton, Southampton, Hampshire, UK
| | - Sabina Stanescu
- Department of Psychology, University of Southampton, Southampton, Hampshire, UK
| | - Felicity L Bishop
- Department of Psychology, University of Southampton, Southampton, Hampshire, UK
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21
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Shaw RL, Bishop FL, Horwood J, Chilcot J, Arden MA. Enhancing the quality and transparency of qualitative research methods in health psychology. Br J Health Psychol 2019; 24:739-745. [PMID: 31654471 DOI: 10.1111/bjhp.12393] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Rachel L Shaw
- Psychology Department, School of Life Science, Aston University, Birmingham, UK
| | | | - Jeremy Horwood
- Centre for Academic Primary Care, Bristol Medical School, University of Bristol, UK
| | - Joseph Chilcot
- Health Psychology Section, Institute for Psychiatry, Psychology and Neuroscience, Kings College, London, UK
| | - Madelynne A Arden
- Centre for Behavioural Science and Applied Psychology, Sheffield Hallam University, UK
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22
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Everitt HA, Landau S, O'Reilly G, Sibelli A, Hughes S, Windgassen S, Holland R, Little P, McCrone P, Bishop FL, Goldsmith K, Coleman N, Logan R, Chalder T, Moss-Morris R. Cognitive behavioural therapy for irritable bowel syndrome: 24-month follow-up of participants in the ACTIB randomised trial. Lancet Gastroenterol Hepatol 2019; 4:863-872. [PMID: 31492643 PMCID: PMC7026694 DOI: 10.1016/s2468-1253(19)30243-2] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Revised: 07/10/2019] [Accepted: 07/18/2019] [Indexed: 12/22/2022]
Abstract
Background Irritable bowel syndrome (IBS) is common, affecting 10–20% of the adult population worldwide, with many people reporting ongoing symptoms despite first-line therapies. Cognitive behavioural therapy (CBT) is recommended in guidelines for refractory IBS but there is insufficient access to CBT for IBS and uncertainty about whether benefits last in the longer term. Assessing Cognitive behavioural Therapy for IBS (ACTIB) was a large, randomised, controlled trial of two forms of CBT for patients with refractory IBS. ACTIB results showed that, at 12 months, both forms of CBT for IBS were significantly more effective than treatment as usual at reducing IBS symptom severity in adults with refractory IBS. This follow-up study aimed to evaluate 24-month clinical outcomes of participants in the ACTIB trial. Methods In the ACTIB three-group, randomised, controlled trial, 558 adults with refractory IBS were randomly allocated to receive either therapist-delivered telephone CBT (telephone-CBT group), web-based CBT with minimal therapist support (web-CBT group), or treatment as usual (TAU group) and were followed up for 12 months. Participants were adults with refractory IBS (clinically significant symptoms for ≥12 months despite being offered first-line therapies), recruited by letter and opportunistically from 74 general practices and three gastroenterology centres in London and the south of England (UK) between May 1, 2014, and March 31, 2016. Primary outcome measures were IBS Symptom Severity Score (IBS-SSS) and Work and Social Adjustment Scale (WSAS), assessed in the intention-to-treat (ITT) population with multiple imputation. This study was a non-prespecified naturalistic follow-up and analysis of the participants of the ACTIB trial at 24 months assessing the same outcomes as the original trial. Outcome measures were completed online by participants or a paper questionnaire was posted, or telephone follow-up undertaken. The ACTIB trial is registered with the International Standard Randomised Controlled Trial Number registry, number ISRCTN44427879. Findings 24-month follow-up of outcomes was achieved for 323 (58%) of 558 participants: 119 (64%) of 186 in the telephone-CBT group, 99 (54%) of 185 in the web-CBT group, and 105 (56%) of 187 in the TAU group. At 24 months, mean IBS-SSS was 40·5 points (95% CI 15·0 to 66·0; p=0·002) lower in the telephone-CBT group and 12·9 points (−12·9 to 38·8; p=0·33) lower in the web-CBT group than in the TAU group. The mean WSAS score was 3·1 points (1·3 to 4·9; p<0·001) lower in the telephone-CBT group and 1·9 points (0·1 to 3·7; p=0·036) lower in the web-CBT group than in the TAU group. A clinically significant IBS-SSS change (≥50 points) from baseline to 24 months was found in 84 (71%) of 119 participants in the telephone-CBT group, in 62 (63%) of 99 in the web-CBT group, and in 48 (46%) of 105 in the TAU group. In total 41 adverse events were reported between 12 to 24 months: 11 in the telephone-CBT group, 15 in the web-CBT group, and 15 in the TAU group. Of these, eight were reported as gastrointestinal related, five as psychological, and six as musculoskeletal. There were no adverse events related to treatment. Interpretation At 24-month follow-up, sustained improvements in IBS were seen in both CBT groups compared with TAU, although some previous gains were reduced compared with the 12-month outcomes. IBS-specific CBT has the potential to provide long-term improvement in IBS, achievable within a usual clinical setting. Increasing access to CBT for IBS could achieve long-term patient benefit. Funding UK National Institute for Health Research.
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Affiliation(s)
- Hazel A Everitt
- School of Primary Care Population Sciences and Medical Education, University of Southampton, Southampton, UK.
| | - Sabine Landau
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Gilly O'Reilly
- School of Primary Care Population Sciences and Medical Education, University of Southampton, Southampton, UK
| | - Alice Sibelli
- Health Psychology Section, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Stephanie Hughes
- School of Primary Care Population Sciences and Medical Education, University of Southampton, Southampton, UK
| | - Sula Windgassen
- Academic Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Rachel Holland
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Paul Little
- School of Primary Care Population Sciences and Medical Education, University of Southampton, Southampton, UK
| | - Paul McCrone
- King's Health Economics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Felicity L Bishop
- Centre for Applications of Health Psychology, University of Southampton, Southampton, UK
| | - Kim Goldsmith
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Nicholas Coleman
- Department of Gastroenterology, Southampton University Hospital, Southampton, UK
| | | | - Trudie Chalder
- Academic Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Rona Moss-Morris
- Health Psychology Section, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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Zhang Y, Dennis JA, Bishop FL, Cramer H, Leach M, Lauche R, Sundberg T, Leung B, Zhang AL, Bacon L, Sibbritt D, Adams J. Complementary and Alternative Medicine Use by U.S. Adults with Self‐Reported Doctor‐Diagnosed Arthritis: Results from the 2012 National Health Interview Survey. PM R 2019; 11:1059-1069. [DOI: 10.1002/pmrj.12124] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Accepted: 12/27/2018] [Indexed: 01/08/2023]
Affiliation(s)
- Yan Zhang
- Department of Family and Community MedicineTexas Tech University Health Sciences Center Lubbock TX
- Australian Research Centre in Complementary and Integrative Medicine (ARCCIM)Faculty of Health, University of Technology Sydney Sydney Australia
| | - Jeff A. Dennis
- Department of Public HealthTexas Tech University Health Sciences Center Lubbock TX
| | - Felicity L. Bishop
- Australian Research Centre in Complementary and Integrative Medicine (ARCCIM)Faculty of Health, University of Technology Sydney Sydney Australia
- Faculty of Social Human and Mathematical SciencesUniversity of Southampton Southampton UK
| | - Holger Cramer
- Australian Research Centre in Complementary and Integrative Medicine (ARCCIM)Faculty of Health, University of Technology Sydney Sydney Australia
- Department of Internal and Integrative Medicine, Kliniken Essen‐Mitte, Faculty of MedicineUniversity of Duisburg‐Essen Essen Germany
| | - Matthew Leach
- Australian Research Centre in Complementary and Integrative Medicine (ARCCIM)Faculty of Health, University of Technology Sydney Sydney Australia
- Department of Rural HealthUniversity of South Australia Adelaide Australia
| | - Romy Lauche
- Australian Research Centre in Complementary and Integrative Medicine (ARCCIM)Faculty of Health, University of Technology Sydney Sydney Australia
- Department of Integrative and Complementary Medicine Sozialstiftung Bamberg Germany
| | - Tobias Sundberg
- Australian Research Centre in Complementary and Integrative Medicine (ARCCIM)Faculty of Health, University of Technology Sydney Sydney Australia
- Musculoskeletal & Sports Injury Epidemiology CenterInstitute of Environmental Medicine, Karolinska Institutet Stockholm Sweden
| | - Brenda Leung
- Australian Research Centre in Complementary and Integrative Medicine (ARCCIM)Faculty of Health, University of Technology Sydney Sydney Australia
- Faculty of Health SciencesUniversity of Lethbridge Lethbridge, AB Canada
| | - Anthony L. Zhang
- Australian Research Centre in Complementary and Integrative Medicine (ARCCIM)Faculty of Health, University of Technology Sydney Sydney Australia
- School of Health and Biomedical SciencesRMIT University Bundoora West Campus Bundoora Australia
| | - Luke Bacon
- School of MedicineTexas Tech University Health Sciences Center Lubbock TX
| | - David Sibbritt
- Australian Research Centre in Complementary and Integrative Medicine (ARCCIM)Faculty of Health, University of Technology Sydney Sydney Australia
| | - Jon Adams
- Australian Research Centre in Complementary and Integrative Medicine (ARCCIM)Faculty of Health, University of Technology Sydney Sydney Australia
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Bishop FL, Greville-Harris M, Bostock J, Din A, Graham CA, Lewith G, Liossi C, O'Riordan T, White P, Yardley L. Supporting informed choice in acupuncture: effects of a new person-, evidence- and theory-based website for patients with back pain. Acupunct Med 2019; 37:98-106. [PMID: 30896248 DOI: 10.1177/0964528419827228] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES To test whether a newly developed person-, theory- and evidence-based website about acupuncture helps patients make informed decisions about whether or not to use acupuncture for back pain. METHODS A randomised online study compared a newly developed 'enhanced website' to a 'standard website'. The enhanced website provided evidence-based information in a person-based manner and targeted psychological constructs. The standard website was based on a widely used patient information leaflet. In total, 350 adults with recent self-reported back pain were recruited from general practices in South West England. The two primary outcomes were knowledge change and making an informed choice about using acupuncture. Secondary outcomes were beliefs about and willingness to have acupuncture. RESULTS Participants who viewed the enhanced acupuncture website had a significantly greater increase in knowledge about acupuncture (M = 1.1, standard deviation (SD) = 1.7) than participants who viewed the standard website (M = 0.2, SD = 1.1; F(1, 315) = 37.93, p < 0.001, η2 = .107). Participants who viewed the enhanced acupuncture website were also 3.3 times more likely to make an informed choice about using acupuncture than those who viewed the standard website (χ2(1) = 23.46, p < 0.001). There were no significant effects on treatment beliefs or willingness to have acupuncture. CONCLUSION The enhanced website improved patients' knowledge and ability to make an informed choice about acupuncture, but did not optimise treatment beliefs or change willingness to have acupuncture. The enhanced website could be used to support informed decision-making among primary care patients and members of the general public considering using acupuncture for back pain.
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Affiliation(s)
- Felicity L Bishop
- 1 Centre for Clinical and Community Applications of Health Psychology, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK
| | - Maddy Greville-Harris
- 1 Centre for Clinical and Community Applications of Health Psychology, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK
| | - Jennifer Bostock
- 2 Institute of Psychiatry, Psychology & Neuroscience (IoPPN), King's College London, London, UK
| | - Amy Din
- 3 Centre for Innovation and Leadership in Health Sciences, University of Southampton, Southampton, UK
| | - Cynthia A Graham
- 1 Centre for Clinical and Community Applications of Health Psychology, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK
| | - George Lewith
- 4 Primary Care and Population Sciences, University of Southampton, Southampton, UK
| | - Christina Liossi
- 1 Centre for Clinical and Community Applications of Health Psychology, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK
| | | | - Peter White
- 3 Centre for Innovation and Leadership in Health Sciences, University of Southampton, Southampton, UK
| | - Lucy Yardley
- 1 Centre for Clinical and Community Applications of Health Psychology, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK.,6 School of Psychological Science, University of Bristol, UK
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Hardman DI, Geraghty AW, Howick J, Roberts N, Bishop FL. A discursive exploration of public perspectives on placebos and their effects. Health Psychol Open 2019; 6:2055102919832313. [PMID: 30800412 PMCID: PMC6378439 DOI: 10.1177/2055102919832313] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
There is increasing evidence that placebos could be effective in clinical practice. However, knowledge of public perspectives on placebos is underdeveloped. We conducted a discourse analysis of internet comments on news articles related to placebos, aiming to improve this knowledge for clinicians and researchers. We developed two discursive constructs of the placebo. The dominant construct of the ‘placebo pill’ informs a paradoxical understanding of placebos that closes down treatment. The less-prevalent counter-discursive construct of the ‘treatment process’ frames placebos as potentially viable within modern evidence-based medicine. We discuss the opportunities and challenges of this alternative understanding of placebos.
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Pokladnikova J, Stefancikova M, Haviger J, Bishop FL, Wang B, Guan X, Musil F. Effect of expectation on short- and long-term treatment response to Acupuncture in migraine patients. Eur J Integr Med 2019. [DOI: 10.1016/j.eujim.2019.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Bishop FL, Greville-Harris M, Bostock J, Din A, Graham CA, Lewith G, Liossi C, O'Riordan T, White P, Yardley L. Informing Adults With Back Pain About Placebo Effects: Randomized Controlled Evaluation of a New Website With Potential to Improve Informed Consent in Clinical Research. J Med Internet Res 2019; 21:e9955. [PMID: 30664462 PMCID: PMC6354200 DOI: 10.2196/jmir.9955] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Revised: 08/28/2018] [Accepted: 10/04/2018] [Indexed: 12/12/2022] Open
Abstract
Background Placebo effects and their underpinning mechanisms are increasingly well understood. However, this is poorly communicated to participants in placebo-controlled trials. For valid informed consent, participants should be informed about the potential benefits and risks of participating in placebo-controlled trials. Existing information leaflets often fail to describe the potential benefits and adverse effects associated with placebo allocation. This study tested the effects of a new website designed to inform patients about placebo effects (The Power of Placebos, PoP). PoP was designed using qualitative methods in combination with theory- and evidence-based approaches to ensure it was engaging, informative, and addressed patients’ concerns. Objective This study aimed to test the effects of PoP, compared with a control website, on people’s knowledge about placebo and the ability to make an informed choice about taking part in a placebo-controlled trial. Methods A total of 350 adults with back pain recruited from 26 general practices in Southern England participated in this Web-based study. Participants were randomly assigned to PoP (which presented scientifically accurate information about placebo effects in an engaging way) or a control website (based on existing information leaflets from UK trials). Participants self-completed Web-based pre- and postintervention questionnaire measures of knowledge about placebo effects and preintervention questionnaire measures of attitudes toward and intentions to participate in a placebo-controlled trial. The 2 primary outcomes were (1) knowledge and (2) informed choice to take part in a placebo-controlled trial (computed from knowledge, attitudes, and intentions). Results After viewing PoP, participants had significantly greater knowledge about placebos (mean 8.28 [SD 1.76]; n=158) than participants who viewed the control (mean 5.60 [SD 2.24]; n=174; F1,329=173.821; P<.001; η2=.346). Participants who viewed PoP were 3.16 times more likely than those who viewed the control to make an informed choice about placebos (χ21=36.5; P<.001). Conclusions In a sample of adults with back pain, PoP increased knowledge and rates of informed choice about placebos compared with a control website. PoP could be used to improve knowledge about placebo effects in back pain. After essential further development and testing in clinical trial settings, it could support informed consent in placebo-controlled trials.
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Affiliation(s)
- Felicity L Bishop
- Department of Psychology, University of Southampton, Southampton, United Kingdom
| | | | - Jennifer Bostock
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Amy Din
- Centre for Innovation & Leadership in Health Sciences, School of Health Sciences, University of Southampton, Southampton, United Kingdom
| | - Cynthia A Graham
- Department of Psychology, University of Southampton, Southampton, United Kingdom
| | - George Lewith
- Primary Care and Population Sciences, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | - Christina Liossi
- Department of Psychology, University of Southampton, Southampton, United Kingdom
| | | | - Peter White
- Centre for Innovation & Leadership in Health Sciences, School of Health Sciences, University of Southampton, Southampton, United Kingdom
| | - Lucy Yardley
- Department of Psychology, University of Southampton, Southampton, United Kingdom.,School of Psychological Science, Faculty of Life Sciences, University of Bristol, Bristol, United Kingdom
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Holmes MM, Bishop FL, Newell D, Field J, Lewith G. Chiropractors' views on the use of patient-reported outcome measures in clinical practice: a qualitative study. Chiropr Man Therap 2018; 26:50. [PMID: 30568787 PMCID: PMC6297946 DOI: 10.1186/s12998-018-0219-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Accepted: 10/31/2018] [Indexed: 11/10/2022] Open
Abstract
Background Patient-reported outcome measures (PROMs) are widely available for use in musculoskeletal care. However, there is little research exploring the implementation of PROMs in clinical practice. This qualitative study explored chiropractors' views on PROMs to identify any barriers and facilitators to implementing PROMs in chiropractic care and the training needs of chiropractors regarding the use of PROMs. Methods A qualitative study of chiropractors' views on PROMs was undertaken as part of a larger project to address the feasibility of conducting a randomised controlled trial of PROM use in chiropractic clinics for patients with low back pain. Contact was made with chiropractors working in chiropractic companies with multiple clinic sites. Semi-structured interviews were conducted with eight chiropractors, either face-to-face at their place of work or over the telephone. The interviews were transcribed verbatim and analysed using thematic analysis. The data were coded inductively by two authors. Results Chiropractors discussed their knowledge and engagement with PROMs in clinical practice, identifying reasons for their use, such as understanding clinic performance, clinical practice, and research. They also discussed how they used PROMs within their clinical practice and the benefits of using them with individual patients, for example during the consultation, identifying yellow flags, and tracking patient progress. Chiropractors voiced concerns about patient engagement with PROMs, questioning if patients find them burdensome, and the appropriate PROMs to use with patients with pain. Finally, chiropractors acknowledged the organisational barriers and facilitators to using PROMs within their practice, such as busy practices, electronic systems, and use of reception staff. Conclusions Using participating chiropractors' views of PROMs, the study identified barriers and facilitators to implementing PROMs in chiropractic care, such as clinician knowledge, engagement, and organisational concerns and identified the potential training needs of chiropractors regarding PROMs. The results from the study suggested chiropractors use PROMs with their individual patients, but PROMs should be meaningful to patients and chiropractors to improve engagement.
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Affiliation(s)
- Michelle M. Holmes
- Department of Psychology, University of Southampton, Southampton, SO17 1BJ UK
| | - Felicity L. Bishop
- Department of Psychology, University of Southampton, Southampton, SO17 1BJ UK
| | - David Newell
- AECC University College, Bournemouth, BH7 2DF UK
| | | | - George Lewith
- Primary Care and Population Science, University of Southampton, Southampton, UK
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Abstract
Objective To evaluate the content of patient information leaflets about acupuncture. Methods 401 patient information leaflets were obtained from practising UK acupuncturists and subjected to content and thematic analysis. Results 59% of included leaflets were from NHS physiotherapists. Almost all the leaflets defined acupuncture and the majority explained how it might work, described the treatment process and placed it in a historical context. Most described possible benefits and risks of acupuncture and discussed contraindications and safety. Just under a third of leaflets (120, 30%) suggested conditions that might be helped by acupuncture, most commonly musculoskeletal pain, arthritis and injuries. By emphasising differences between individuals in acupuncture treatments and responsiveness, the leaflets fostered hope for positive effects without making any guarantees. Conclusions Information leaflets are broadly consistent with the evidence for acupuncture, but some claims are inconsistent with official advice from advertising regulators. An ethically sound, scientifically grounded and psychologically effective leaflet should accurately convey both benefits and risks of treatment, optimise patients’ expectations and allay concerns about needling. This study suggests that acupuncture leaflets might achieve these multiple functions but care should be taken to ensure adequate coverage of risks.
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Affiliation(s)
- Felicity L Bishop
- Centre for Applications of Health Psychology, University of Southampton, Southampton, UK
| | - Cathy Salmon
- Centre for Applications of Health Psychology, University of Southampton, Southampton, UK
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Barker SL, Maguire N, Bishop FL, Stopa LL. Expert viewpoints of peer support for people experiencing homelessness: A Q sort study. Psychol Serv 2018; 16:402-414. [PMID: 30382744 DOI: 10.1037/ser0000258] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Peers have shared experiences of phenomena such as mental illness, addiction, and homelessness. Homelessness services are increasingly utilizing peers in their models to support people experiencing homelessness. While there is extensive literature on peer support in general, few studies focus on the potential change mechanisms that might underpin this intervention, particularly regarding homelessness. This study aims to utilize expert opinions to identify common viewpoints on components involved in effective peer support. Forty-three statements were developed from previous literature that broadly describes elements involved in peer support. Forty experts (20 peers and 20 professionals) ranked the statements into a hierarchy. Q methodology is a rigorous method to objectively research participants' subjective viewpoints, using a by-person rather than by-variable approach to factor analysis. The study was done in three stages: first-order analysis to identify shared viewpoints within (a) the peer participant group, (b) the professional participant group, and (c) a second-order analysis of Stage 1 and 2 results to identify common viewpoints held across participant groups. Stage 3 analysis resulted in three differing viewpoints; the dominant viewpoint asserts that effective peer support is rooted in experiential knowledge, where peers build unique, trusting relationships to provide clients with a different level of support. The results highlighted different types of peer support and defined a new one: a unidirectional, mentorship type of intentional peer support. Strengths and limitations are discussed. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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Hardman DI, Geraghty AW, Lewith G, Lown M, Viecelli C, Bishop FL. From substance to process: A meta-ethnographic review of how healthcare professionals and patients understand placebos and their effects in primary care. Health (London) 2018; 24:315-340. [PMID: 30238795 DOI: 10.1177/1363459318800169] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Research suggests that a 'placebo' can improve conditions common in primary care including pain, depression and irritable bowel syndrome. However, disagreement persists over the definition and clinical relevance of placebo treatments. We conducted a meta-ethnographic, mixed-research systematic review to explore how healthcare professionals and patients understand placebos and their effects in primary care. We conducted systematic literature searches of five databases - augmented by reference chaining, key author searches and expert opinion - related to views on placebos, placebo effects and placebo use in primary care. From a total of 34 eligible quantitative, qualitative and mixed-methods articles reporting findings from 28 studies, 21 were related to healthcare professionals' views, 11 were related to patients' views and two were related to both groups. In the studies under review, healthcare professionals reported using placebos at markedly different frequencies. This was highly influenced by how placebos were defined in the studies. Both healthcare professionals and patients predominantly defined placebos as material substances such as 'inert' pills, despite this definition being inconsistent with current scientific thinking. However, healthcare professionals also, but less prevalently, defined placebos in a different way: as contextual processes. This better concurs with modern placebo definitions, which focus on context, ritual, meaning and enactivism. However, given the enduring ubiquity of substance definitions, for both healthcare professionals and patients, we question the practical, clinical validity of stretching the term 'placebo' towards its modern iteration. To produce 'placebo effects', therefore, primary healthcare professionals may be better off abandoning placebo terminology altogether.
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Barker SL, Maguire N, Bishop FL, Stopa L. Peer support critical elements and experiences in supporting the homeless: A qualitative study. J Community Appl Soc Psychol 2018. [DOI: 10.1002/casp.2353] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Stephanie L. Barker
- School of Psychology; University of Southampton; Building 44, University Rd Southampton SO17 1BJ UK
| | - Nick Maguire
- School of Psychology; University of Southampton; Building 44, University Rd Southampton SO17 1BJ UK
| | - Felicity L. Bishop
- School of Psychology; University of Southampton; Building 44, University Rd Southampton SO17 1BJ UK
| | - Lusia Stopa
- School of Psychology; University of Southampton; Building 44, University Rd Southampton SO17 1BJ UK
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Howick J, Moscrop A, Mebius A, Fanshawe TR, Lewith G, Bishop FL, Mistiaen P, Roberts NW, Dieninytė E, Hu XY, Aveyard P, Onakpoya IJ. Effects of empathic and positive communication in healthcare consultations: a systematic review and meta-analysis. J R Soc Med 2018; 111:240-252. [PMID: 29672201 DOI: 10.1177/0141076818769477] [Citation(s) in RCA: 151] [Impact Index Per Article: 25.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Background Practitioners who enhance how they express empathy and create positive expectations of benefit could improve patient outcomes. However, the evidence in this area has not been recently synthesised. Objective To estimate the effects of empathy and expectations interventions for any clinical condition. Design Systematic review and meta-analysis of randomised trials. Data sources Six databases from inception to August 2017. Study selection Randomised trials of empathy or expectations interventions in any clinical setting with patients aged 12 years or older. Review methods Two reviewers independently screened citations, extracted data, assessed risk of bias and graded quality of evidence using GRADE. Random effects model was used for meta-analysis. Results We identified 28 eligible (n = 6017). In seven trials, empathic consultations improved pain, anxiety and satisfaction by a small amount (standardised mean difference -0.18 [95% confidence interval -0.32 to -0.03]). Twenty-two trials tested the effects of positive expectations. Eighteen of these (n = 2014) reported psychological outcomes (mostly pain) and showed a modest benefit (standardised mean difference -0.43 [95% confidence interval -0.65 to -0.21]); 11 (n = 1790) reported physical outcomes (including bronchial function/ length of hospital stay) and showed a small benefit (standardised mean difference -0.18 [95% confidence interval -0.32 to -0.05]). Within 11 trials (n = 2706) assessing harms, there was no evidence of adverse effects (odds ratio 1.04; 95% confidence interval 0.67 to 1.63). The risk of bias was low. The main limitations were difficulties in blinding and high heterogeneity for some comparisons. Conclusions Greater practitioner empathy or communication of positive messages can have small patient benefits for a range of clinical conditions, especially pain. Protocol registration Cochrane Database of Systematic Reviews (protocol) DOI: 10.1002/14651858.CD011934.pub2.
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Affiliation(s)
- Jeremy Howick
- 1 Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford OX1 2JD, UK
| | - Andrew Moscrop
- 1 Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford OX1 2JD, UK
| | - Alexander Mebius
- 1 Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford OX1 2JD, UK
| | - Thomas R Fanshawe
- 1 Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford OX1 2JD, UK
| | - George Lewith
- 2 Psychology, University of Southampton, Southampton SO17 1BJ, UK
| | | | - Patriek Mistiaen
- 3 Belgian Health Care Knowledge Centre (KCE), Brussels B-1000, Belgium
| | - Nia W Roberts
- 4 Bodleian Health Care Libraries, University of Oxford, Oxford OX1 2JD, UK
| | - Eglė Dieninytė
- 5 Faculty of Medicine, Vilnius University, Vilnius LT-03101, Lithuania
| | - Xiao-Yang Hu
- 2 Psychology, University of Southampton, Southampton SO17 1BJ, UK
| | - Paul Aveyard
- 1 Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford OX1 2JD, UK
| | - Igho J Onakpoya
- 1 Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford OX1 2JD, UK
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Harvey JM, Sibelli A, Chalder T, Everitt H, Moss-Morris R, Bishop FL. Desperately seeking a cure: Treatment seeking and appraisal in irritable bowel syndrome. Br J Health Psychol 2018; 23:561-579. [PMID: 29508539 PMCID: PMC6175452 DOI: 10.1111/bjhp.12304] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Revised: 02/01/2018] [Indexed: 12/13/2022]
Abstract
Objectives Irritable bowel syndrome (IBS) is common and adversely affects patients' quality of life. Multiple potential treatment options exist for patients (and clinicians) to choose from, with limited evidence to inform treatment selection. The aim was to explore how patients with IBS go about seeking and appraising different treatment modalities, with a view to elucidating the psychological processes involved and identifying opportunities to improve clinical practice. Design Qualitative study nested within a randomized controlled trial of therapist‐delivered and web‐based cognitive behavioural therapy versus treatment‐as‐usual for IBS. Methods A total of 52 people participated in semi‐structured interviews about their prior experiences of treatments for IBS. Transcripts were analysed using inductive thematic analysis. Results Key themes (desperation for a cure, disappointment at lack of cure, appraising the effects of diverse treatments, and hope for positive effects) clustered around an overarching theme of being trapped within a vicious cycle of hope and despair on treatment seeking. A desperation and willingness drove interviewees to try any treatment modality available that might potentially offer relief. Coming to accept there is no cure for IBS helped interviewees escape the vicious cycle. Treatments were appraised for their effects on symptoms and quality of life while also considering, but rarely prioritizing, other aspects including convenience of the regimen itself, whether it addressed the perceived root causes of IBS, perceived side‐effects, and cost. Conclusion Treatment seeking in IBS can be challenging for patients. Supportive discussions with health care professionals about illness perceptions, treatment beliefs, and goals could improve patients' experiences. Statement of contribution What is already known on this subject? Irritable bowel syndrome (IBS) is a highly prevalent chronic relapsing functional gastrointestinal disorder. Studies show few treatment modalities provide complete symptom relief. IBS is associated with emotional and physical distress, and negatively impacts personal, social, and professional aspects of quality of life.
What does this study add? Patients appraise IBS treatments for impact on quality of life and treatment characteristics. Developing acceptance and coping strategies helps escape treatment‐seeking vicious cycles of hope and despair. Clinicians could better support patients by discussing their illness perceptions, treatment goals, and values.
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Affiliation(s)
- J Matthew Harvey
- Centre for Clinical and Community Applications of Health Psychology, Department of Psychology, Faculty of Social Human and Mathematical Sciences, University of Southampton, UK
| | - Alice Sibelli
- Health Psychology Section, Institute of Psychiatry, Psychology and Neuroscience, Kings College London, UK
| | - Trudie Chalder
- Academic Department of Psychological Medicine, Kings College London, UK
| | - Hazel Everitt
- Primary Care and Population Sciences, Faculty of Medicine, University of Southampton, UK
| | - Rona Moss-Morris
- Health Psychology Section, Institute of Psychiatry, Psychology and Neuroscience, Kings College London, UK
| | - Felicity L Bishop
- Centre for Clinical and Community Applications of Health Psychology, Department of Psychology, Faculty of Social Human and Mathematical Sciences, University of Southampton, UK
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Abstract
Background: Anxiety is a prevalent mental health condition in the Western world. Adults experiencing anxiety have been found to use a range of herbal medicines to manage anxiety symptoms.Aim: This study aimed to test a theoretical model based on the theory of planned behaviour that predicted the intention to use herbal medicines for anxiety symptoms, and to identify individual predictors of intention.Methods: An online survey was conducted with Australian adults who experienced anxiety and used herbal medicines (N = 400). A two-step approach to structural equation modelling was used to test a path model predicting the intention to use herbal medicines.Results: The model was found to be well-fitting. Attitude, subjective norms, control beliefs and severity of anxiety symptoms each significantly positively predicted intention to use herbal medicines for anxiety symptoms explaining 56% of the variance.Conclusions: The results suggest that mental health practitioners and policy makers need to ensure people experiencing anxiety have access to accurate and reliable information about herbal medicines to ensure they can effectively manage anxiety symptoms and safely engage in self-care.
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Affiliation(s)
- Erica McIntyre
- School of Psychology, Charles Sturt University, Australia.,Australian Research Centre in Complementary and Integrative Medicine, University of Technology Sydney, Ultimo, Australia, and
| | | | | | - Felicity L Bishop
- Australian Research Centre in Complementary and Integrative Medicine, University of Technology Sydney, Ultimo, Australia, and.,Department of Psychology, University of Southampton, Southampton, UK
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Hughes J, Greville-Harris M, Graham CA, Lewith G, White P, Bishop FL. What trial participants need to be told about placebo effects to give informed consent: a survey to establish existing knowledge among patients with back pain. J Med Ethics 2017; 43:867-870. [PMID: 28663259 PMCID: PMC5827710 DOI: 10.1136/medethics-2016-103964] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Revised: 04/25/2017] [Accepted: 05/14/2017] [Indexed: 06/02/2023]
Abstract
INTRODUCTION Patients require an accurate knowledge about placebos and their possible effects to ensure consent for placebo-controlled clinical trials is adequately informed. However, few previous studies have explored patients' baseline (ie, pretrial recruitment) levels of understanding and knowledge about placebos. The present online survey aimed to assess knowledge about placebos among patients with a history of back pain. DESIGN A 15-item questionnaire was constructed to measure knowledge about placebos. Additional questions assessed sociodemographic characteristics, duration and severity of back pain, and previous experience of receiving placebos. SETTING Participants recruited from community settings completed the study online. RESULTS 210 participants completed the questionnaire. 86.7% had back pain in the past 6 months, 44.3% currently had back pain. 4.3% had received a placebo intervention as part of a clinical trial and 68.1% had previously read or heard information about placebos. Overall knowledge of placebos was high, with participants on average answering 12.07 of 15 questions about placebos correctly (SD=2.35). However, few participants correctly answered questions about the nocebo effect (31.9% correct) and the impact of the colour of a placebo pill (55.2% correct). CONCLUSIONS The findings identified key gaps in knowledge about placebos. The lack of understanding of the nocebo effect in particular has implications for the informed consent of trial participants. Research ethics committees and investigators should prioritise amending informed consent procedures to incorporate the fact that participants in the placebo arm might experience adverse side effects.
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Affiliation(s)
- John Hughes
- Royal London Hospital for Integrated Medicine, London, UK
| | | | - Cynthia A Graham
- Department of Psychology, University of Southampton, Southampton, UK
| | - George Lewith
- School of Medicine, Southampton University, Southampton, UK
| | - Peter White
- Department of Health Sciences, University of Southampton, Southampton, UK
| | - Felicity L Bishop
- Department of Psychology, University of Southampton, Southampton, UK
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Filbay SR, Bishop FL, Peirce N, Jones ME, Arden NK. Physical activity in former elite cricketers and strategies for promoting physical activity after retirement from cricket: a qualitative study. BMJ Open 2017; 7:e017785. [PMID: 29151050 PMCID: PMC5701977 DOI: 10.1136/bmjopen-2017-017785] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Revised: 10/06/2017] [Accepted: 10/12/2017] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVES The health benefits of professional sport dissipate after retirement unless an active lifestyle is adopted, yet reasons for adopting an active or inactive lifestyle after retirement from sport are poorly understood. Elite cricket is all-encompassing, requiring a high volume of activity and unique physical demands. We aimed to identify influences on physical activity behaviours in active and insufficiently active former elite cricketers and provide practical strategies for promoting physical activity after cricket retirement. DESIGN 18 audio-recorded semistructured telephone interviews were performed. An inductive thematic approach was used and coding was iterative and data-driven facilitated by NVivo software. Themes were compared between sufficiently active and insufficiently active participants. SETTING All participants formerly played professional cricket in the UK. PARTICIPANTS Participants were male, mean age 57±11 (range 34-77) years, participated in professional cricket for 12±7 seasons and retired on average 23±9 years previously. Ten participants (56%) were classified as sufficiently active according to the UK Physical Activity Guidelines (moderate-intensity activity ≥150 min per week or vigorous-intensity activity ≥75 min per week). Eight participants did not meet these guidelines and were classified as insufficiently active. RESULTS Key physical activity influences were time constraints, habit formation, intrinsic and extrinsic motivation, physical activity preferences, pain/physical impairment and cricket coaching. Recommendations for optimising physical activity across the lifespan after cricket retirement included; prioritise physical activity, establish a physical activity plan prior to cricket retirement and don't take a break from physical activity, evaluate sources of physical activity motivation and incorporate into a physical activity plan, find multiple forms of satisfying physical activity that can be adapted to accommodate fluctuations in physical capabilities across the lifespan and coach cricket. CONCLUSIONS Physically active and less active retired cricketers shared contrasting attributes that informed recommendations for promoting a sustainable, physically active lifestyle after retirement from professional cricket.
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Affiliation(s)
- Stephanie R Filbay
- Arthritis Research UK Centre for Sport, Exercise & Osteoarthritis, Nuffield Department of Orthopaedics, Rheumatology & Musculoskeletal Sciences, Botnar Research Centre, University of Oxford, Oxford, UK
| | - Felicity L Bishop
- Department of Psychology, University of Southampton, Southampton, UK
| | - Nicholas Peirce
- National Centre For Sports and Exercise Medicine and National Cricket Performance Centre, Loughborough University, Loughborough, UK
- National Cricket Performance Centre, Loughborough University, Loughborough, UK
| | - Mary E Jones
- Nuffield Department of Orthopaedics, Rheumatology & Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Nigel K Arden
- Arthritis Research UK Centre for Sport, Exercise & Osteoarthritis, Nuffield Department of Orthopaedics, Rheumatology & Musculoskeletal Sciences, Botnar Research Centre, University of Oxford, Oxford, UK
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Howick J, Fanshawe TR, Mebius A, Lewith G, Heneghan CJ, Bishop FL, Little P, Mistiaen P, Roberts NW. Effects of changing practitioner empathy and patient expectations in healthcare consultations. Hippokratia 2017. [DOI: 10.1002/14651858.cd011934.pub2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Jeremy Howick
- University of Oxford; Nuffield Department of Primary Care Health Sciences; Oxford UK
| | - Thomas R Fanshawe
- University of Oxford; Nuffield Department of Primary Care Health Sciences; Oxford UK
| | - Alexander Mebius
- University of Oxford; Nuffield Department of Primary Care Health Sciences; Oxford UK
| | | | - Carl J Heneghan
- University of Oxford; Nuffield Department of Primary Care Health Sciences; Oxford UK
| | - Felicity L Bishop
- University of Southampton; Building 44 Highfield Campus Southampton UK SO17 1BJ
| | - Paul Little
- Aldermoor Health Centre, University of Southampton; Primary Care and Population Sciences, Faculty of Medicine; Aldermoor Close Southampton UK S016 5ST
| | - Patriek Mistiaen
- Belgian Health Care Knowledge Centre (KCE); Administrative Centre Botanique, Doorbuilding (10th floor) Boulevard du Jardin Botanique 55 Brussels Belgium B-1000
| | - Nia W Roberts
- University of Oxford; Bodleian Health Care Libraries; Knowledge Centre, ORC Research Building, Old Road Campus Oxford Oxfordshire UK OX3 7DQ
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Sibelli A, Chalder T, Everitt H, Workman P, Bishop FL, Moss-Morris R. The role of high expectations of self and social desirability in emotional processing in individuals with irritable bowel syndrome: A qualitative study. Br J Health Psychol 2017; 22:737-762. [PMID: 28862389 DOI: 10.1111/bjhp.12264] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Revised: 07/21/2017] [Indexed: 12/13/2022]
Abstract
OBJECTIVES Although high levels of distress are associated with the onset and severity of Irritable bowel syndrome (IBS), it is unclear how this relates to emotional processing, particularly in relation to maintenance of symptoms and treatment outcome. This qualitative study embedded within a randomized controlled trial aimed to explore how individuals with refractory IBS experience, express, and manage their emotions after either therapist-delivered cognitive behavioural therapy (TCBT) or Web-based CBT (WBCBT) compared to treatment as usual (TAU). DESIGN Cross-sectional qualitative study. METHODS Fifty-two semi-structured interviews were conducted at post-treatment with 17 TCBT, 17 WBCBT, and 18 TAU participants. The transcripts were analysed using inductive thematic analysis with grounded theory elements. NVivo 11 was used to compare themes across groups. RESULTS Across all groups, high expectations of self was a recurring reason for how participants experienced and expressed their emotions. Three themes with subthemes captured how high expectations related to specific aspects of emotional processing: perceived causes of emotions, strategies for coping with emotions (bottling up, avoiding emotions, and active coping strategies), and the perceived interplay between emotions and IBS symptoms. CONCLUSIONS Patients recognized that their IBS symptoms both triggered and were triggered by negative emotions. However, there was a tendency to bottle up or avoid negative emotions for reasons of social desirability regardless of whether patients had CBT for IBS or not. Future psychological interventions in IBS may benefit from addressing negative beliefs about expressing emotions, promoting assertive emotional expression, and encouraging the experience of positive emotions. Statement of contribution What is already known on this subject? High levels of distress are consistently associated with both the onset and maintenance of IBS symptoms. Little is known about how this relates to the concept of emotional processing. Preliminary findings suggest a positive correlation between poor emotional processing and IBS. However, further studies need to confirm its role in relation to aetiology, maintenance of symptoms, and response to treatment. What does this study add? High expectations of self and social desirability seem to be important aspects shaping the way individuals with IBS experience, express, and manage their emotions. Emotional avoidance and bottling up were reported as key strategies to cope with negative emotions. The study revealed that bottling up is not perceived as an all-or-nothing strategy but can be applied selectively depending on the context. Psychological interventions in IBS may benefit from addressing not only illness-related causes of negative emotions but also personal and social triggers of distress.
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Affiliation(s)
- Alice Sibelli
- Health Psychology Section, Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Trudie Chalder
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, Weston Education Centre, King's College London, UK
| | - Hazel Everitt
- Primary Care and Population Sciences, Aldermoor Health Centre, University of Southampton, UK
| | - Paul Workman
- Health Psychology Section, Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | | | - Rona Moss-Morris
- Health Psychology Section, Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
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40
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Zhang Y, Dennis JA, Leach MJ, Bishop FL, Cramer H, Chung VCH, Moore C, Lauche R, Cook R, Sibbritt D, Adams J. Complementary and Alternative Medicine Use Among US Adults With Headache or Migraine: Results from the 2012 National Health Interview Survey. Headache 2017; 57:1228-1242. [PMID: 28742215 DOI: 10.1111/head.13148] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Revised: 06/05/2017] [Accepted: 06/05/2017] [Indexed: 12/14/2022]
Abstract
BACKGROUND Given the safety concerns regarding pharmacological agents, and the considerable impact of headache and migraine on the sufferer's quality of life, many people seek other treatment options beyond conventional medication and care to address their symptoms; this includes complementary and alternative medicine (CAM). Some CAM interventions have shown promising results in clinical trials of headache and migraine management. Nonetheless, there has been little research exploring the reasons for using CAM, and the types of CAM used, among this population. OBJECTIVE The study aimed to answer the following questions: (1) Which CAM modalities are used most frequently among migraine/headache sufferers? and (2) What are the self-reported reasons for CAM use among migraine/headache sufferers? METHODS This secondary analysis of data from the 2012 U.S. NHIS (a national cross-sectional survey) examined the use of CAM among migraine/headache sufferers, including the main reasons related to CAM use. Data were weighted and analyzed using STATA 14.0. RESULTS The sample of 34,525 adults included 6558 (18.7%) headache/migraine sufferers. Of the headache/migraine sufferers, a substantial proportion (37.6%, n = 2427) used CAM for various conditions; however, CAM use specifically for headache/migraine was much less prevalent (3.3%, n = 216). Of those who used CAM for headache/migraine, about half used CAM in conjunction with prescription (47.8%, n = 100) or over-the-counter medication (55.1%, n = 113). As severity of headache/migraine increased so did the likelihood of using CAM (severe migraine odds ratio [OR] = 2.32; 95% confidence interval [CI]: 1.41, 3.82; both recurring headache/severe migraine OR = 3.36; 95% CI: 2.08, 5.43; when compared to those with recurring headache only). The most frequently used CAM modality among all headache/migraine sufferers (N = 6558) was manipulative therapy (22.0%, n = 1317), herbal supplementation (21.7%, n = 1389) and mind-body therapy (17.9%, n = 1100). The top 3 reasons for using CAM for headache were general wellness (28.7%, n = 60/209), improving overall health (26.8%, n = 56/209), and reducing stress (16.7%, n = 35/209). CONCLUSIONS Although CAM is used by many sufferers of headache/migraine, the use of CAM specifically for the treatment of headache/migraine is relatively low in the United States. The study also assesses the key differences of CAM use among headache/migraine sufferers in NHIS 2012 compared with those in NHIS 2007, and identifies shortfalls in the evidence-base of several CAM modalities used by U.S. adults for headache/migraine. This information may assist health providers and consumers in making informed decisions about the safest and most appropriate approach to managing headache/migraine.
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Affiliation(s)
- Yan Zhang
- Department of Family and Community Medicine, Texas Tech University Health Sciences Center, Lubbock, TX, USA.,Australian Research Centre in Complementary and Integrative Medicine (ARCCIM), Faculty of Health, University of Technology Sydney, Sydney, Australia
| | - Jeff A Dennis
- Department of Public Health, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - Matthew J Leach
- Department of Rural Health, University of South Australia, Adelaide, Australia.,Australian Research Centre in Complementary and Integrative Medicine (ARCCIM), Faculty of Health, University of Technology Sydney, Sydney, Australia
| | - Felicity L Bishop
- Faculty of Social Human and Mathematical Sciences, University of Southampton, Southampton, UK.,Australian Research Centre in Complementary and Integrative Medicine (ARCCIM), Faculty of Health, University of Technology Sydney, Sydney, Australia
| | - Holger Cramer
- Department of Internal and Integrative Medicine, Kliniken Essen-Mitte, Faculty of Medicine, University of Duisburg-Essen, Essen, Germany.,Australian Research Centre in Complementary and Integrative Medicine (ARCCIM), Faculty of Health, University of Technology Sydney, Sydney, Australia
| | - Vincent C H Chung
- JC School of Public Health and Primary Care, Hong Kong Institute of Integrative Medicine, The Chinese University of Hong Kong, Hong Kong.,Australian Research Centre in Complementary and Integrative Medicine (ARCCIM), Faculty of Health, University of Technology Sydney, Sydney, Australia
| | - Craig Moore
- Australian Research Centre in Complementary and Integrative Medicine (ARCCIM), Faculty of Health, University of Technology Sydney, Sydney, Australia
| | - Romy Lauche
- Australian Research Centre in Complementary and Integrative Medicine (ARCCIM), Faculty of Health, University of Technology Sydney, Sydney, Australia
| | - Ron Cook
- Department of Family and Community Medicine, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - David Sibbritt
- Australian Research Centre in Complementary and Integrative Medicine (ARCCIM), Faculty of Health, University of Technology Sydney, Sydney, Australia
| | - Jon Adams
- Australian Research Centre in Complementary and Integrative Medicine (ARCCIM), Faculty of Health, University of Technology Sydney, Sydney, Australia
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Ee C, Thuraisingam S, Pirotta M, French S, Xue C, Teede H, Kristoffersen AE, Sirois F, Stub T, Engler J, Joos S, Güthlin C, Felenda J, Beckmann C, Stintzing F, Evans R, Bronfort G, Keefe D, Taberko A, Hanson L, Haley A, Ma H, Jolton J, Yarosh L, Keefe F, Nam J, Evans R, Ojala L, Kreitzer MJ, Hanson L, Fink C, Kraft K, Flower A, Lewith G, Harman K, Stuart B, Bishop FL, Frawley J, Füleki L, Kiss E, Vancsik T, Krenacs T, Funabashi M, Pohlman KA, Mior S, Thiel H, Hill MD, Cassidy DJ, Westaway M, Yager J, Hurwitz E, Kawchuk GN, O’Beirne M, Vohra S, Gaboury I, Morin C, Gaertner K, Torchetti L, Frei-Erb M, Kundi M, Frass M, Gallo E, Maggini V, Comite M, Sofi F, Baccetti S, Vannacci A, Di Stefano M, Monechi MV, Gori L, Rossi E, Firenzuoli F, Mediati RD, Ballerini G, Gardiner P, Lestoquoy AS, Negash L, Stillman S, Shah P, Liebschutz J, Adelstein P, Farrell-Riley C, Brackup I, Penti B, Saper R, Sampedro IG, Carvajal G, Gleiss A, Gross MM, Brendlin D, Röttger J, Stritter W, Seifert G, Grzanna N, Stange R, Guendling PW, Gu W, Lu Y, Wang J, Zhang C, Hajimonfarednejad M, Hannan N, Hellsing R, Wode K, Nordberg JH, Nordberg JH, Andermo S, Arman M, von Hörsten I, Torrielo PV, Bai H, Vilaró CLA, Cabrera FC, Huber R, Hui H, Ziea E, Tsui D, Hsieh J, Lam C, Chan E, Jensen MP, He Y, Battalio SL, Chan J, Edwards KA, Gertz KJ, Day MA, Sherlin LH, Ehde DM, Kim KH, Jang S, Jang BH, Zhang X, Go HY, Park S, Ko SG, Kraft K, Janik H, Börner A, Lee J, Lee B, Chang GT, Menassa A, Zhang Z, Motoo Y, Müller J, Rabini S, Vinson B, Kelber O, Storr M, Kraft K, Niemeijer M, Baars E, Hoekman J, Wang D, Ruijssenaaars W, Njoku FC, Klose P, Brinkhaus B, Michalsen A, Dobos G, Cramer H, Norheim AJ, Alræk T, Okumus F, Meng F, Oncu-Celik H, Hagel A, Albrecht H, Vollbracht C, Dauth W, Hagel W, Vitali F, Ganzleben I, Schultis H, Konturek P, Stein J, Neurath M, Raithel M, Hagel A, Vollbracht C, Raithel M, Konturek P, Krick B, Haller H, Klose P, Dobos G, Kümmel S, Cramer H, Haller H, Saha FJ, Kowoll A, Ebner B, Berger B, Dobos G, Choi KE, He L, Wang H, He X, Gu C, Zhang Y, Zhao L, Tong X, He L, Wang H, He X, Gu C, Zhang Y, Zhao L, Tong X, He L, Wang H, He X, Gu C, Zhang Y, Zhao L, Tong X, Ho RST, Chung VCH, Wu X, Wong CHL, Wu JCY, Wong SYS, Lau AYL, Sit RWS, Wong W, Holmes M, Bishop F, Calman L, Holmes M, Bishop F, Lewith G, Newell D, Field J, Htut WL, Han D, Choi DI, Choi SJ, Kim HY, Hwang JH, Huang CW, Jang BH, Chen FP, Ko SG, Huang W, Jin D, Lian F, Jang S, Kim KH, Lee EK, Sun SH, Go HY, Ko Y, Park S, Jang BH, Shin YC, Ko SG, Janik H, Greiffenhagen N, Bolte J, Kraft K, Jaworski M, Adamus M, Dobrzynska A, Jeitler M, Jaspers J, von Scheidt C, Koch B, Michalsen A, Steckhan N, Kessler C, Jin D, Huang WJ, Pang B, Lian FM, Jong M, Baars E, Glockmann A, Hamre H, Kainuma M, Murakami A, Kubota T, Kobayashi D, Sumoto Y, Furusyo N, Ando SI, Shimazoe T, Kelber O, Verjee S, Gorgus E, Schrenk D, Kemper K, Hill E, Kemper K, Rao N, Gascon G, Mahan J, Kienle G, Dietrich J, Schmoor C, Huber R, Kim WH, Han D, Ahmed M, He L, Hwang JH, Kiss E, Vancsik T, Meggyeshazi N, Kovago C, Krenacs T, Klaus AK, Zerm R, Pranga D, Ostermann T, Reif M, von Laue HB, Brinkhaus B, Kröz M, Klaus AK, Zerm R, Pranga D, Recchia DR, Ostermann T, Reif M, von Laue HB, Brinkhaus B, Kröz M, Klein-Laansma CT, Jong M, von Hagens C, Jansen JP, van Wietmarschen H, Jong MC, Ko Y, Sun SH, Go HY, Jeon CY, Song YK, Ko SG, Koch AK, Rabsilber S, Lauche R, Kümmel S, Dobos G, Langhorst J, Cramer H, Koch AK, Trifunovic-Koenig M, Klose P, Cramer H, Dobos G, Langhorst J, Koster E, Baars E, Delnoij D, Kroll L, Weiss K, Kubo A, Hendlish S, Altschuler A, Connolly N, Avins A, Lauche R, Recchia DR, Cramer H, Wardle J, Lee D, Sibbritt D, Adams J, Ostermann T, Lauche R, Sibbritt D, Park C, Mishra G, Adams J, Cramer H, Lechner J, Lee I, Chae Y, Lee J, Cho SH, Choi Y, Lee JY, Ryu HS, Yoon SS, Oh HK, Hyun LK, Kim JO, Yoon SW, Lee JY, Shin SH, Jang M, Müller I, Park SHJ, Lestoquoy AS, Laird L, Negash L, Mitchell S, Gardiner P, Li X, Wang Y, Zhen J, Yu H, Liu T, Gu X, Liu H, Ma W, Zhang C, Shang X, Bai Y, Meng F, Liu W, Rooney C, Smith A, Lopes S, Demarzo M, do Patrocínio Nunes M, Lorenz P, Gründemann C, Heinrich M, Garcia-Käufer M, Grunewald F, Messerschmidt S, Herrick A, Gruber K, Beckmann C, Knödler M, Huber R, Steinborn C, Stintzing F, Lu T, Wang L, Wu D, Luberto CM, Hall DL, Chad-Friedman E, Lechner S, Park ER, Luberto CM, Park E, Goodman J, Luer S, Heri M, von Ammon K, Frei-Erb M, Ma W, Meng F, Maggini V, Gallo E, Landini I, Lapucci A, Nobili S, Mini E, Firenzuoli F, McDermott C, Lewith G, Richards S, Cox D, Frossell S, Leydon G, Eyles C, Raphael H, Rogers R, Selby M, Adler C, Allam J, Meng F, Gu W, Zhang C, Bai H, Zhang Z, Wang D, Bu X, Zhang H, Zhang J, Liu H, Mikolasek M, Berg J, Witt C, Barth J, Miskulin I, Lalic Z, Miskulin M, Dumic A, Sebo D, Vcev A, Mohammed NAA, Han D, Ahmed M, Choi SJ, Im HB, Hwang JH, Mukherjee A, Kandhare A, Bodhankar S, Mukherjee A, Kandhare A, Thakurdesai P, Bodhankar S, Munk N, Evans E, Froman A, Kline M, Bair MJ, Musial F, Kristoffersen AE, Alræk T, Hamre HJ, Stub T, Björkman L, Fønnebø VM, Pang B, Lian FM, Ni Q, Tong XL, Li XL, Liu WK, Feng S, Zhao XY, Zheng YJ, Zhao XM, Lin YQ, Pang B, Lian FM, Tong XL, Zhao TY, Zhao XY, Phd HC, Zhang C, Pang B, Liu F, Tong XL, Zhao LH, Zhao XM, Ye R, Gu CJ, Pang B, Ni Q, Tong XL, Lian FM, Zhao XY, Jin D, Zhao XM, Zheng YJ, Lin YQ, Peng W, Lauche R, Sibbritt D, Adams J, Peng W, Wardle J, Cramer H, Mishra G, Lauche R, Pohlman KA, Mior S, Funabashi M, De Carvalho D, El-Bayoumi M, Haig B, Kelly K, Wade DJ, O’Beirne M, Vohra S, Portalupi E, Gobo G, Bellavita L, Guglielmetti C, Raak C, Teuber M, Molsberger F, von Rath U, Reichelt U, Schwanebeck U, Zeil S, Vogelberg C, Veintimilla DR, Vollbracht C, Mery GT, Villavicencio MM, Moran SH, Sachse C, Gündlin PW, Stange R, Sahebkarkhorasani M, Azizi H, Schumann D, Lauche R, Sundberg T, Leach MJ, Cramer H, Seca S, Greten H, Selliah S, Shakya A, Han D, Kim HY, Choi DI, Im HB, Choi SJ, Sherbakova A, Ulrich-Merzenich G, Kelber O, Abdel-Aziz H, Sibinga E, Webb L, Ellen J, Skrautvol K, Nåden D, Song R, Grabowska W, Osypiuk K, Diaz GV, Bonato P, Park M, Hausdorff J, Fox M, Sudarsky LR, Tarsy D, Novakowski J, Macklin EA, Wayne PM, Song R, Hwang I, Ahn S, Lee MA, Wayne PM, Sohn MK, Sorokin O, Steckhan N, Heydeck D, Borchert A, Hohmann CD, Kühn H, Michalsen A, Kessler C, Steckhan N, Hohmann CD, Cramer H, Michalsen A, Dobos G, von Scheidt C, Kirschbaum C, Stalder T, Stöckigt B, Teut M, Suhr R, Sulmann D, Brinkhaus B, Streeter C, Gerbarg P, Silveri M, Brown R, Jensen J, Stritter W, Rutert B, Eggert A, Längler A, Seifert G, Holmberg C, Sun J, Deng X, Li WY, Wen B, Robinson N, Liu JP, Sung HK, Yang N, Go HY, Shin SM, Jung H, Kim YJ, Jung WS, Park TY, Suzuki K, Ito T, Uchida S, Kamohara S, Ono N, Takamura M, Yokochi A, Maruyama K, Tapia P, Thabaut K, Brinkhaus B, Stöckigt B, Thronicke A, Kröz M, Steele M, Matthes H, Herbstreit C, Schad F, Tian J, Lian F, Yang L, Tong X, Tian T, Zhang H, Tian X, Wang C, Chai QY, Zhang L, Xia R, Huang N, Fei Y, Liu J, Trent N, Miraglia M, Dusek J, Pasalis E, Khalsa SB, Trifunovic-König M, Klose P, Cramer H, Lauche R, Koch A, Dobos G, Langhorst J, Uebelacker L, Tremont G, Gillette L, Epstein-Lubow G, Strong D, Abrantes A, Tyrka A, Tran T, Gaudiano B, Miller I, Ullmann G, Ullmann G, Li Y, Vaidya S, Marathe V, Vale AC, Motta J, Donadão F, Valente AC, Valente LCC, Ghelman R, Vesovic D, Jevdic D, Jevdic A, Jevdic K, Djacic M, Letic D, Bozic D, Markovic M, Dunjic S, Vesovic D, Jevdic D, Jevdic A, Jevdic K, Djacic M, Letic D, Bozic D, Markovic M, Ruscuklic G, Baksa D, Dunjic S, Vesovic D, Jevdic D, Jevdic A, Jevdic K, Djacic M, Letic D, Bozic D, Markovic M, Ruscuklic G, Baksa D, Dunjic S, Vesovic D, Jevdic D, Jevdic A, Jevdic K, Djacic M, Letic D, Bozic D, Markovic M, Ruscuklic G, Baksa D, Dunjic S, Vesovic D, Jevdic D, Jevdic A, Jevdic K, Djacic M, Letic D, Bozic D, Markovic M, Vrca K, Dunjic S, Vincent A, Wahner-Roedler D, Whipple M, Vogelius MM, Vollbracht C, Friesecke I, Gündling PW, Wahner-Roedler D, Mahapatra S, Hynes R, Van Rooy K, Looker S, Ghosh A, Bauer B, Cutshall S, Walach H, Flores AB, Walach H, Ofner M, Kastner A, Schwarzl G, Schwameder H, Alexander N, Strutzenberger G, Wang J, Lu Y, Gu W, Zhang C, Bu X, Zhang H, Zhang J, He Y, Zhang X, Meng F, Wang S, Yu H, Shi J, Hao Y, Liu T, Wu J, Qiu Z, Gu X, Wang YH, Lou CJ, Watts S, Wayne P, Osypiuk K, Vergara-Diaz G, Bonato P, Gow B, Hausdorff J, Miranda J, Sudarsky L, Tarsy D, Fox M, Macklin E, Wode K, Bergqvist J, Bernhardsson BM, Nordberg JH, Kienle G, Sharp L, Henriksson R, Woo Y, Hyun MK, Wu H, Wang TF, Zhao Y, Wei Y, Tian L, He L, Wang X, Wu R, Feng S, Han M, Caldwell PHY, Liu S, Zhang J, Liu J, Xia R, Chai Q, Fei Y, Guo Z, Wang C, Liu Z, Li X, Zhang Y, Liu J, Yang IJ, Lincha VR, Ahn SH, Lee DU, Shin HM, Yang L, Sibbritt D, Peng W, Adams J, Yang N, Sung H, Shin SM, Go HY, Jung H, Kim Y, Park TY, Yap A, Kwan YH, Tan CS, Ibrahim S, Ang SB, Yayi A, Han D, Im HB, Hwang JH, Choi SJ, Yoo JE, Yoo HR, Jang SB, Lee HL, Youssef A, Ezzat S, Motaal AA, El-Askary H, Yu X, Cui Y, Zhang Y, Lian F, Yun Y, Ko Y, Ahn JH, Jang BH, Kim KS, Ko SG, Choi I, Zerm R, Glinz A, Pranga D, Berger B, ten Brink F, Reif M, Büssing A, Gutenbrunner C, Kröz M, Zerm R, Helbrecht B, Pranga D, Brinkhaus B, Michalsen A, Kröz M, Zhang H, Fang T, Wang J, Zhang C, He Y, Zhang X, Zhang Z, Wang D, Meng F, Zhang J, Zhang C, Bai H, Shen Z, Ma W, Liu H, Bai Y, Shang X, Meng F, Zhang R, Wu F, Li M, Xuan X, Shen X, Ren K, Berman B, Zhen J, Li X, Gu X, Yu H, Zheng Z, Wan Y, Wang Y, Ma X, Dong F, Liu T, Zhen J, Li X, Gu X, Yu H, Zheng Z, Wan Y, Wang Y, Ma X, Dong F, Liu T, Zick S, Harris R, Bae GE, Kwon JN, Lee HY, Nam JK, Lee SD, Lee DH, Han JY, Yun YJ, Lee JH, Park HL, Park SH, Bocci C, Ivaldi GB, Vietti I, Meaglia I, Guffi M, Ruggiero R, Gualea M, Longa E, Bonucci M, Croke S, Rodriguez LD, Caracuel-Martínez JC, Fajardo-Rodríguez MF, Ariza-García A, la Fuente FGD, Arroyo-Morales M, Estrems MS, Gómez VG, Estrems MS, Sabater MV, Ferreri R, Bernardini S, Pulcri R, Cracolici F, Rinaldi M, Porciani C, Firenzuoli F, Baccetti S, Di Stefano M, Monechi MV, Gallo E, Maggini V, Gori L, Rossi E, Fisher P, Hughes J, Mendoza A, MacPherson H, Witt C, Filshie J, Lewith G, Di Francesco A, Bernardini A, Messe M, Primitivo V, Iasella PA, Ghelman R, Taminato M, Alcantara JDC, De Oliveira KR, Rodrigues DCDA, Mumme JRC, Sunakozawa OKM, Filho VO, Seifert G, Goldenberg J, Day A, Sasagawa M, Ward L, Cooley K, Gunnarsdottir T, Hjaltadottir I. World Congress Integrative Medicine & Health 2017: part two. BMC Complement Altern Med 2017. [PMCID: PMC5498867 DOI: 10.1186/s12906-017-1783-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Bishop FL, Coghlan B, Geraghty AWA, Everitt H, Little P, Holmes MM, Seretis D, Lewith G. What techniques might be used to harness placebo effects in non-malignant pain? A literature review and survey to develop a taxonomy. BMJ Open 2017; 7:e015516. [PMID: 28667217 PMCID: PMC5734496 DOI: 10.1136/bmjopen-2016-015516] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVES Placebo effects can be clinically meaningful but are seldom fully exploited in clinical practice. This review aimed to facilitate translational research by producing a taxonomy of techniques that could augment placebo analgesia in clinical practice. DESIGN Literature review and survey. METHODS We systematically analysed methods which could plausibly be used to elicit placebo effects in 169 clinical and laboratory-based studies involving non-malignant pain, drawn from seven systematic reviews. In a validation exercise, we surveyed 33 leading placebo researchers (mean 12 years’ research experience, SD 9.8), who were asked to comment on and add to the draft taxonomy derived from the literature. RESULTS The final taxonomy defines 30 procedures that may contribute to placebo effects in clinical and experimental research, proposes 60 possible clinical applications and classifies procedures into five domains: the patient’s characteristics and belief (5 procedures and 11 clinical applications), the practitioner’s characteristics and beliefs (2 procedures and 4 clinical applications), the healthcare setting (8 procedures and 13 clinical applications), treatment characteristics (8 procedures and 14 clinical applications) and the patientâ€"practitioner interaction (7 procedures and 18 clinical applications). CONCLUSION The taxonomy provides a preliminary and novel tool with potential to guide translational research aiming to harness placebo effects for patient benefit in practice.
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Affiliation(s)
- Felicity L Bishop
- Department of Psychology, Faculty of Social Human and Mathematical Sciences, University of Southampton, Southampton, UK
| | - Beverly Coghlan
- Primary Care and Population Sciences, Aldermoor Health Centre, University of Southampton, Southampton, UK
| | - Adam WA Geraghty
- Primary Care and Population Sciences, Aldermoor Health Centre, University of Southampton, Southampton, UK
| | - Hazel Everitt
- Primary Care and Population Sciences, Aldermoor Health Centre, University of Southampton, Southampton, UK
| | - Paul Little
- Primary Care and Population Sciences, Aldermoor Health Centre, University of Southampton, Southampton, UK
| | - Michelle M Holmes
- Department of Psychology, Faculty of Social Human and Mathematical Sciences, University of Southampton, Southampton, UK
| | - Dionysis Seretis
- Department of Psychology, Faculty of Social Human and Mathematical Sciences, University of Southampton, Southampton, UK
| | - George Lewith
- Primary Care and Population Sciences, Aldermoor Health Centre, University of Southampton, Southampton, UK
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Holmes MM, Bishop FL, Calman L. "I just googled and read everything": Exploring breast cancer survivors' use of the internet to find information on complementary medicine. Complement Ther Med 2017; 33:78-84. [PMID: 28735830 DOI: 10.1016/j.ctim.2017.06.007] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Revised: 05/13/2017] [Accepted: 06/26/2017] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE Breast cancer survivors often turn to the internet as an information resource when deciding whether to use complementary and alternative medicine (CAM) but their use of online CAM-related resources is poorly understood. The objective was to explore breast cancer survivors' use of the internet when making decisions about CAM use. DESIGN A purposive sample of 11 breast cancer survivors (mean age=56) completed a quantitative questionnaire and a qualitative telephone interview. The theory of planned behaviour (TPB) was used to guide interview questions. Framework analysis and descriptive statistics were used. SETTING United Kingdom. RESULTS All participants found information on CAM using the internet and used some form of CAM after their diagnosis. Themes from the interviews went beyond the standard definitions of the TPB areas. Despite the lack of approval from their social network and healthcare team, participants used the internet to find information on CAM. Further, participants' cancer diagnosis changed their needs, transforming how they perceived and experienced the internet CONCLUSIONS: Participants' use of the internet was more complex than can easily be explained by the TPB and was inherently connected to the experience of self-management for the consequences of cancer and its treatment. As breast cancer survivors may not disclose their use of the internet to their healthcare team, healthcare professionals need to be aware that the information available on the internet plays a factor in the decision-making process to use CAM.
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Affiliation(s)
- Michelle M Holmes
- School of Psychology, University of Southampton, Building 44, University Road, Southampton, Hampshire, SO17 1BJ, UK.
| | - Felicity L Bishop
- School of Psychology, University of Southampton, Building 44, University Road, Southampton, Hampshire, SO17 1BJ, UK
| | - Lynn Calman
- Faculty of Health Sciences, University of Southampton, Building 67, University Road, Southampton, Hampshire, SO17 1BJ, UK
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Steel A, Sundberg T, Reid R, Ward L, Bishop FL, Leach M, Cramer H, Wardle J, Adams J. Reply to the letter to the editor: 'Systematic review of comparative effectiveness and health economics research relating to osteopathic manipulative treatment'. Musculoskelet Sci Pract 2017; 29:e18. [PMID: 28189458 DOI: 10.1016/j.msksp.2017.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Amie Steel
- Australian Research Centre in Complementary and Integrative Medicine, Faculty of Health, University of Technology Sydney, 15 Broadway, Ultimo, NSW 2007, Australia; Endeavour College of Natural Health, Level 2, 269 Wickham St, Fortitude Valley, QLD 4006, Australia.
| | - Tobias Sundberg
- Research Unit for Studies of Integrative Health Care, Karolinska Institutet (NVS/OMV), Alfred Nobels Alle 23, 141 83 Stockholm, Sweden; Australian Research Centre in Complementary and Integrative Medicine, Faculty of Health, University of Technology Sydney, 15 Broadway, Ultimo, NSW 2007, Australia
| | - Rebecca Reid
- Endeavour College of Natural Health, Level 2, 269 Wickham St, Fortitude Valley, QLD 4006, Australia
| | - Lesley Ward
- Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences (NDORMS), B4495, Oxford OX3 7LD, University of Oxford, United Kingdom; Australian Research Centre in Complementary and Integrative Medicine, Faculty of Health, University of Technology Sydney, 15 Broadway, Ultimo, NSW 2007, Australia
| | - Felicity L Bishop
- Centre for Applications of Health Psychology, Faculty of Social Human and Mathematical Sciences, Building 44 Highfield Campus, University of Southampton, Southampton, SO17 1BJ, United Kingdom; Australian Research Centre in Complementary and Integrative Medicine, Faculty of Health, University of Technology Sydney, 15 Broadway, Ultimo, NSW 2007, Australia
| | - Matthew Leach
- School of Nursing & Midwifery, Health Economics & Social Policy Group, University of South Australia, 101 Currie St, Adelaide, Australia; Australian Research Centre in Complementary and Integrative Medicine, Faculty of Health, University of Technology Sydney, 15 Broadway, Ultimo, NSW 2007, Australia
| | - Holger Cramer
- Department of Internal and Integrative Medicine, Kliniken Essen-Mitte, Faculty of Medicine, University of Duisburg-Essen, 45141 Duisburg, Germany; Australian Research Centre in Complementary and Integrative Medicine, Faculty of Health, University of Technology Sydney, 15 Broadway, Ultimo, NSW 2007, Australia
| | - Jon Wardle
- Australian Research Centre in Complementary and Integrative Medicine, Faculty of Health, University of Technology Sydney, 15 Broadway, Ultimo, NSW 2007, Australia
| | - Jon Adams
- Australian Research Centre in Complementary and Integrative Medicine, Faculty of Health, University of Technology Sydney, 15 Broadway, Ultimo, NSW 2007, Australia
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Abstract
Lack of knowledge about placebos affects participants’ understanding of trials and breaches the ethical obligations of researchers, argue C R Blease, F L Bishop, and T J Kaptchuk
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Affiliation(s)
- C R Blease
- School of Philosophy, University College Dublin, Ireland
- Program in Placebo Studies, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, MA, USA
| | - F L Bishop
- Department of Psychology, University of Southampton, UK
| | - T J Kaptchuk
- Program in Placebo Studies, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, MA, USA
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Steel A, Sundberg T, Reid R, Ward L, Bishop FL, Leach M, Cramer H, Wardle J, Adams J. Osteopathic manipulative treatment: A systematic review and critical appraisal of comparative effectiveness and health economics research. Musculoskelet Sci Pract 2017; 27:165-175. [PMID: 27852531 DOI: 10.1016/j.math.2016.10.067] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Revised: 10/25/2016] [Accepted: 10/27/2016] [Indexed: 12/30/2022]
Abstract
In recent years, evidence has emerged regarding the effectiveness of osteopathic manipulative treatments (OMT). Despite growing evidence in this field, there is need for appropriate research designs that effectively reflect the person-centred system of care promoted in osteopathy and provide data which can inform policy decisions within the healthcare system. The purpose of this systematic review is to identify, appraise and synthesise the evidence from comparative effectiveness and economic evaluation research involving OMT. A database search was conducted using CINAHL, PubMed, PEDro, AMED, SCOPUS and OSTMED.DR, from their inception to May 2015. Two separate searches were undertaken to identify original research articles encompassing the economic evaluation and comparative effectiveness of OMT. Identified comparative effectives studies were evaluated using the Cochrane risk of bias tool and appraised using the Good Reporting of Comparative Effectiveness (GRACE) principles. Identified economic studies were assessed with the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) guidelines. Sixteen studies reporting the findings of comparative effectiveness (n = 9) and economic evaluation (n = 7) research were included. The comparative effectiveness studies reported outcomes for varied health conditions and the majority (n = 6) demonstrated a high risk of bias. The economic evaluations included a range of analyses and considerable differences in the quality of reporting were evident. Despite some positive findings, published comparative effectiveness and health economic studies in OMT are of insufficient quality and quantity to inform policy and practice. High quality, well-designed, research that aligns with international best practice is greatly needed to build a pragmatic evidence base for OMT.
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Affiliation(s)
- Amie Steel
- Australian Research Centre in Complementary and Integrative Medicine, Faculty of Health, University of Technology Sydney, 15 Broadway, Ultimo, NSW, 2007, Australia; Endeavour College of Natural Health, Level 2, 269 Wickham St, Fortitude Valley, QLD, 4006, Australia.
| | - Tobias Sundberg
- Australian Research Centre in Complementary and Integrative Medicine, Faculty of Health, University of Technology Sydney, 15 Broadway, Ultimo, NSW, 2007, Australia; Research Unit for Studies of Integrative Health Care, Karolinska Institutet (NVS/OMV), Alfred Nobels Alle 23, 141 83, Stockholm, Sweden
| | - Rebecca Reid
- Endeavour College of Natural Health, Level 2, 269 Wickham St, Fortitude Valley, QLD, 4006, Australia
| | - Lesley Ward
- Australian Research Centre in Complementary and Integrative Medicine, Faculty of Health, University of Technology Sydney, 15 Broadway, Ultimo, NSW, 2007, Australia; Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences (NDORMS), B4495, Oxford, OX3 7LD, University of Oxford, Oxford, United Kingdom
| | - Felicity L Bishop
- Australian Research Centre in Complementary and Integrative Medicine, Faculty of Health, University of Technology Sydney, 15 Broadway, Ultimo, NSW, 2007, Australia; Centre for Applications of Health Psychology, Faculty of Social Human and Mathematical Sciences, Building 44 Highfield Campus, University of Southampton, Southampton, SO17 1BJ, United Kingdom
| | - Matthew Leach
- Australian Research Centre in Complementary and Integrative Medicine, Faculty of Health, University of Technology Sydney, 15 Broadway, Ultimo, NSW, 2007, Australia; School of Nursing & Midwifery, Health Economics & Social Policy Group, University of South Australia, 101 Currie St, Adelaide, Australia
| | - Holger Cramer
- Australian Research Centre in Complementary and Integrative Medicine, Faculty of Health, University of Technology Sydney, 15 Broadway, Ultimo, NSW, 2007, Australia; Department of Internal and Integrative Medicine, Kliniken Essen-Mitte, Faculty of Medicine, University of Duisburg-Essen, 45141, Duisburg, Germany
| | - Jon Wardle
- Australian Research Centre in Complementary and Integrative Medicine, Faculty of Health, University of Technology Sydney, 15 Broadway, Ultimo, NSW, 2007, Australia
| | - Jon Adams
- Australian Research Centre in Complementary and Integrative Medicine, Faculty of Health, University of Technology Sydney, 15 Broadway, Ultimo, NSW, 2007, Australia
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Bogosian A, Morgan M, Bishop FL, Day F, Moss-Morris R. Adjustment modes in the trajectory of progressive multiple sclerosis: a qualitative study and conceptual model. Psychol Health 2016; 32:343-360. [DOI: 10.1080/08870446.2016.1268691] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Angeliki Bogosian
- School of Health Sciences, City, University of London, London, UK
- Psychology Department, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Myfanwy Morgan
- Institute of Pharmaceutical Science, King’s College London, London, UK
| | | | - Fern Day
- School of Health Sciences, City, University of London, London, UK
| | - Rona Moss-Morris
- Psychology Department, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
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Holmes MM, Lewith G, Newell D, Field J, Bishop FL. The impact of patient-reported outcome measures in clinical practice for pain: a systematic review. Qual Life Res 2016; 26:245-257. [PMID: 27815820 PMCID: PMC5288411 DOI: 10.1007/s11136-016-1449-5] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/28/2016] [Indexed: 01/10/2023]
Abstract
Purpose Patient-reported outcome measures (PROMs) have increasingly been incorporated into clinical practice. Research suggests that PROMs could be viewed as active components of complex interventions and may affect the process and outcome of care. This systematic review examines PROMs in the context of treatment for non-malignant pain. Methods An electronic search on: MEDLINE, EMBASE, PsycINFO, PsycARTICLES, Cochrane Library and Web of Science identified relevant papers (February 2015). The inclusion criteria were: focused on implementing PROMs into clinical practice, adults, and primary data studies. Critical interpretive synthesis was used to synthesise qualitative and quantitative findings into a theoretical argument. Results Thirteen eligible studies were identified. Synthesis suggested that PROMs may be included in the initial consultation to assess patients and for shared decision-making regarding patient care. During the course of treatment, PROMs can be used to track progress, evaluate treatment, and change the course of care; using PROMs may also influence the therapeutic relationship. Post-treatment, using PROMs might directly influence other outcomes such as pain and patient satisfaction. However, although studies have investigated these areas, evidence is weak and inconclusive. Conclusion Due to the poor quality, lack of generalisability and heterogeneity of these studies, it is not possible to provide a comprehensive understanding of how PROMs may impact clinical treatment of non-malignant pain. The literature suggests that PROMs enable pain assessment, decision-making, the therapeutic relationship, evaluation of treatment and may influence outcomes. Further research is needed to provide better evidence as to whether PROMs do indeed have any effects on these domains.
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Affiliation(s)
- Michelle M Holmes
- School of Psychology, University of Southampton, Southampton, Hampshire, SO17 1BJ, UK.
| | - George Lewith
- Primary Medical Care, University of Southampton, Southampton, Hampshire, SO16 5ST, UK
| | - David Newell
- Anglo-European College of Chiropractic, Bournemouth, Dorset, BH5 2DF, UK
| | | | - Felicity L Bishop
- School of Psychology, University of Southampton, Southampton, Hampshire, SO17 1BJ, UK
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Greville-Harris M, Hughes J, Lewith G, Liossi C, White P, Graham CA, Bishop FL. Assessing knowledge about acupuncture: A survey of people with back pain in the UK. Complement Ther Med 2016; 29:164-168. [PMID: 27912942 PMCID: PMC5139617 DOI: 10.1016/j.ctim.2016.10.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Revised: 09/26/2016] [Accepted: 10/06/2016] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES Despite the prevalence of acupuncture treatment in the UK, and the increasing evidence of safety and effectiveness, the information presented to patients by practitioners frequently contains inaccuracies. As knowledge of treatment affects both patient decision-making and treatment outcomes, this study aimed to establish what is known about acupuncture in a sample of people who had, and had not, previously experienced acupuncture. DESIGN A 15-item questionnaire was constructed to assess knowledge of acupuncture. SETTING Online survey of people with a history of back pain. RESULTS 202 participants completed the questionnaire. 66.8% of the sample was female and 33.2% male, with a mean age of 35 years (range 18-74 years). 87.6% had back pain in the past six months, 44.1% currently. 21.8% had previously received acupuncture, and 69.8% had previously read or heard information about acupuncture. On average participants answered 11.03 of 15 questions about acupuncture correctly (SD=2.64). Items relating to common concerns about acupuncture, acupuncture efficacy, and types of acupuncture were correctly answered by ≥80% of participants. Participants possessed less knowledge of accessibility, Government legislation, and methods of administration. CONCLUSIONS The study identified key gaps in knowledge about acupuncture among patients. In particular, many participants were unaware that acupuncture is available from the UK National Health Service and that acupuncturists are not subject to statutory regulation in the UK. These knowledge gaps should be addressed in order to increase people's understanding of and access to acupuncture.
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Affiliation(s)
| | - John Hughes
- Royal London Hospital for Integrated Medicine, UCLH NHS Trust, London, UK
| | - George Lewith
- School of Medicine, University of Southampton, Southampton, UK
| | - Christina Liossi
- Department of Psychology, University of Southampton, Southampton, UK
| | - Peter White
- Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - Cynthia A Graham
- Department of Psychology, University of Southampton, Southampton, UK
| | - Felicity L Bishop
- Department of Psychology, University of Southampton, Southampton, UK.
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Bishop FL, Greville-Harris M, Bostock J, Din A, Graham CA, Lewith G, Liossi C, O'Riordan T, Ryves R, White P, Yardley L. Using psychological theory and qualitative methods to develop a new evidence-based website about acupuncture for back pain. Eur J Integr Med 2016; 8:384-393. [PMID: 27807469 PMCID: PMC5078494 DOI: 10.1016/j.eujim.2016.05.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
INTRODUCTION Potential acupuncture patients seek out information about acupuncture from various sources including websites, many of which are unreliable. We aimed to create an informative, scientifically accurate and engaging website to educate patients about acupuncture for back pain and modify their beliefs in a way that might enhance its clinical effects. METHODS We used psychological theory and techniques to design an evidence-based website, incorporating multimedia elements. We conducted qualitative "think aloud" audio-recorded interviews to elicit user views of the website. A convenience sample of ten participants (4 male; aged 21-64 years from the local community) looked at the website in the presence of a researcher and spoke their thoughts out loud. Comments were categorised by topic. RESULTS The website comprises 11 main pages and addresses key topics of interest to potential acupuncture patients, including beneficial and adverse effects, mechanisms of action, safety, practicalities, and patients' experiences of acupuncture. It provides information through text, evidence summaries and audio-clips of four patients' stories and two acupuncturists' descriptions of their practice, and three short films. Evidence from the think aloud study was used to identify opportunities to make the website more informative, engaging, and user-friendly. CONCLUSIONS Using a combination of psychological theory and qualitative interviews enabled us to produce a user-friendly, evidence-based website that is likely to change patients' beliefs about acupuncture for back pain. Before using the website in clinical settings it is necessary to test its effects on key outcomes including patients' beliefs and capacity for making informed choices about acupuncture.
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Affiliation(s)
- Felicity L Bishop
- Centre for Applications of Health Psychology, Faculty of Social and Human Sciences, Building 44 Highfield Campus, University of Southampton, Southampton SO17 1BJ, United Kingdom
| | - Maddy Greville-Harris
- Centre for Applications of Health Psychology, Faculty of Social and Human Sciences, Building 44 Highfield Campus, University of Southampton, Southampton SO17 1BJ, United Kingdom
| | - Jennifer Bostock
- Institute of Psychiatry, Psychology & Neuroscience (IoPPN), King's College London, United Kingdom
| | - Amy Din
- Centre for Innovation & Leadership in Health Sciences, Faculty of Health Sciences, University of Southampton, Highfield Campus, SO17 1BJ, United Kingdom
| | - Cynthia A Graham
- Centre for Applications of Health Psychology, Faculty of Social and Human Sciences, Building 44 Highfield Campus, University of Southampton, Southampton SO17 1BJ, United Kingdom
| | - George Lewith
- Primary Care and Population Sciences, Aldermoor Health Centre, University of Southampton, Southampton, SO16 5ST, United Kingdom
| | - Christina Liossi
- Centre for Applications of Health Psychology, Faculty of Social and Human Sciences, Building 44 Highfield Campus, University of Southampton, Southampton SO17 1BJ, United Kingdom
| | - Tim O'Riordan
- Zemedia, Bitterne Park, Southampton, SO18 1NH, United Kingdom
| | - Rachel Ryves
- Primary Care and Population Sciences, Aldermoor Health Centre, University of Southampton, Southampton, SO16 5ST, United Kingdom
| | - Peter White
- Centre for Innovation & Leadership in Health Sciences, Faculty of Health Sciences, University of Southampton, Highfield Campus, SO17 1BJ, United Kingdom
| | - Lucy Yardley
- Centre for Applications of Health Psychology, Faculty of Social and Human Sciences, Building 44 Highfield Campus, University of Southampton, Southampton SO17 1BJ, United Kingdom
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